Organization
PATHMARK STORES INC
Active
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
Other names
PATHMARK PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
Authorized official
SUSAN D KIJOWSKI (MANAGER, REGULATORY COMPLIANCE)
(201) 571-8326
Entity
Organization
Contact information
Practice address
101 WICKS RD, BRENTWOOD, NY 11717-3523
(631) 436-7522
(631) 436-7541
Mailing address
2 PARAGON DR, MONTVALE, NJ 07645-1718
(201) 573-9700
(201) 571-8335
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
021142
NY
333600000X
Pharmacy
Primary
021142
NY
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01272155
—
NY
01
—
3399739
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/20/2006
Last updated
08/11/2014
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