Organization
PATHMARK STORES, INC.
Active
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
Other names
PATHMARK PHARMACY # 171
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
Authorized official
SUSAN D KIJOWSKI (PHARMACY SPECIALIST)
(201) 571-8326
Entity
Organization
Contact information
Practice address
2660 HYLAN BLVD, STATEN ISLAND, NY 10306-4355
(718) 668-2972
(718) 668-2974
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
029643
NY
333600000X
Pharmacy
Primary
029643
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029643
STATE LICENSE
NY
Enumeration date
07/30/2009
Last updated
03/07/2023
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