Pathmark Stores Inc
Organization Active NPI Pharmacy · Beverly, NJ
NPI 1285733253 · NPPES record last updated Sep 29, 2008
Key facts
- NPI
- 1285733253
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- RS02202 (NJ)
- Legal business name
- PATHMARK STORES INC
- Practice address
- 2110 RT 130
Beverly, NJ 08010 - Phone
- (609) 871-1550
- Fax
- (609) 877-7719
- NPI assigned
- Sep 22, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- THE GREAT ATLANTIC & PACIFIC TEA CO INC
Authorized official
- Name
- Susan D Kijowski
- Title
- Pharmacy Specialist
- Phone
- (201) 571-8326
Practitioners 1
-
Anthony Affigato, R.PH.
National Provider Directory
- Part of
- Great Atlantic Pacific Tea Company Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | RS02202 | NJ | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
2110 RT 130
Beverly, NJ 08010
Mailing address
2 Paragon Dr
Montvale, NJ 07645-1718
Phone (201) 573-9700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3102720 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 4291409 | Medicaid | NJ |
Other names
- PATHMARK PHARMACY
Other providers in Beverly, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.