Active NPI
Pathmark Stores Inc
- Pharmacy
- Philadelphia, PA
National Provider Identifier
1114024981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- PP415487L
- Legal business name
- PATHMARK STORES INC
- Doing business as
- PATHMARK PHARMACY
- Practice address
- 2900 N Broad St
Philadelphia, PA 19132-2400 - Phone
- (215) 226-0446
- Fax
- (215) 226-0781
- NPI assigned
- Sep 20, 2006
- Organization subpart
- Yes
- Parent organization
- THE GREAT ATLANTIC & PACIFIC TEA CO INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan D Kijowski
- Title
- Pharmacy Specialist
- Phone
- (201) 571-8326
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | PP415487L | PA | |
| Pharmacy | 333600000X | PP415487L | PA | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
2900 N Broad St
Philadelphia, PA 19132-2400
Mailing address
2 Paragon Dr
Montvale, NJ 07645-1718
Phone (201) 573-9700
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0017374600002 | Medicaid | PA | |
| 3975604 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- PATHMARK PHARMACY
National Provider Directory
National Provider Directory- Part of
- Great Atlantic Pacific Tea Company Inc
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1214784000000",
"number": "1114024981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 PARAGON DR",
"city": "MONTVALE",
"state": "NJ",
"postal_code": "076451718",
"telephone_number": "201-573-9700",
"fax_number": "201-571-8335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 N BROAD ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191322400",
"telephone_number": "215-226-0446",
"fax_number": "215-226-0781"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PATHMARK STORES INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "THE GREAT ATLANTIC & PACIFIC TEA CO INC",
"enumeration_date": "2006-09-20",
"last_updated": "2008-06-30",
"status": "A",
"authorized_official_last_name": "KIJOWSKI",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "PHARMACY SPECIALIST",
"authorized_official_telephone_number": "201-571-8326"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "PA",
"license": "PP415487L",
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "PA",
"license": "PP415487L",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0017374600002",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "3975604",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "PATHMARK PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.