Big Y Foods, Inc.
Organization Active NPI Community/Retail Pharmacy · Stafford Springs, CT
NPI 1043421068 · NPPES record last updated Feb 18, 2016
Key facts
- NPI
- 1043421068
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PCY.0002093 (CT)
- Legal business name
- BIG Y FOODS, INC.
- Practice address
- 87-C West Stafford Springs Plaza
Route 190
Stafford Springs, CT 06076 - Phone
- (860) 684-4597
- Fax
- (860) 684-5082
- NPI assigned
- May 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. George Pappas
- Title
- Sr Manager of Pharmacy Services
- Phone
- (413) 504-4492
Other NPIs on the same Medicare enrollment 16
Corporate family (same tax ID) 35
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091009000236 | CT | Part B Supplier - Mass Immunization (Roster Biller Only) | 9335285089 |
19 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Torrington, CT; Tolland, CT; Stratford, CT; Stafford Springs, CT; Old Saybrook, CT; Norwich, CT; Mansfield Center, CT; North Branford, CT… |
| O20100930074552 | CT | DME Supplier - Pharmacy | 9335285089 | Practice locations: Stafford Springs, CT |
National Provider Directory
- Tax ID family
- Big Y Foods Inc
Locations
87 W Stafford Rd
Ste C
Stafford Springs, CT 06076
Phone (860) 684-4597
2145 Roosevelt Ave
Springfield, MA 01104
Phone (413) 504-4492
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | PCY.2093 | CT | |
| Community/Retail Pharmacy | 3336C0003X | PCY.0002093 | CT | Yes |
Addresses
Primary practice location
87-C West Stafford Springs Plaza
Route 190
Stafford Springs, CT 06076
Mailing address
2145 Roosevelt Ave
Springfield, MA 01104-1650
Phone (413) 504-4492
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PCY.0002093 | Other | CT | STATE PHARMACY LICENSE |
| 004269339 | Medicaid | CT |
Other names
- Big Y Pharmacy #17
Other providers in Stafford Springs, CT
- Associates for Women'S Wellness, LLC
- Monica Baker
- Lori Anne Belmont
- Kris Best
- Domenick Bianchi
- Joel Steven Bogner
- Michelle Anne Bracci
- Shawn Richard Brady
- Joseph Albert Breton
- Alexandrea Capo Burdick
All providers in Stafford Springs, CT · Community/Retail Pharmacy in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.