Organization
PATHMARK STORES INC
Active
Parent organization
GREAT ATLANTIC & PACIFIC TEA CO., INC, THE.
Other names
PATHMARK PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREAT ATLANTIC & PACIFIC TEA CO., INC, THE.
Authorized official
SUSAN D KIJOWSKI (MANAGER, REGULATORY COMPLIANCE)
(201) 571-8326
Entity
Organization
Contact information
Practice address
5145 NESCONSET HWY, PORT JEFFERSON STATION, NY 11776-2047
(631) 331-2210
(631) 473-3291
Mailing address
PO BOX 416369, BOSTON, MA 02241-6369
(201) 571-4568
(201) 571-8335
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
016040
NY
333600000X
Pharmacy
Primary
016040
NY
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00490111
—
NY
01
—
3364229
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/20/2006
Last updated
08/16/2013
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