Organization
PATHMARK STORES INC
Active
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA CO
Other names
PATHMARK PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE GREAT ATLANTIC & PACIFIC TEA CO
Authorized official
SUSAN D KIJOWSKI (PHARMACY SPECIALIST)
(201) 571-8326
Entity
Organization
Contact information
Practice address
3020 STATE ROUTE 35, HAZLET, NJ 07730-1505
(732) 739-2302
(732) 264-0730
Mailing address
2 PARAGON DR, MONTVALE, NJ 07645-1718
(201) 573-9700
(201) 571-8526
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
RS2800325300
NJ
333600000X
Pharmacy
Primary
RS002209
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3102768
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
4300408
—
NJ
Enumeration date
09/20/2006
Last updated
12/12/2008
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