NPIMap

Organization Active NPI

Pathmark Stores Inc

  • Pharmacy
  • Wyncote, PA
National Provider Identifier
1306943170
Registry record updated Apr 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PP413033L Issued in PA
Legal business name
PATHMARK STORES INC
Practice address
1000 Easton Rd 100
Wyncote, PA 19095-2918
Phone
(215) 572-7440
Fax
(215) 572-7893
NPI assigned
Sep 20, 2006
Organization subpart
Yes
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA CO INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 22, 2011

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)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X PP413033L PA
Pharmacy 333600000X PP413033L PA Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

1000 Easton Rd 100
Wyncote, PA 19095-2918

Mailing address

2 Paragon Dr
Montvale, NJ 07645-1718
Phone (201) 573-9700

Other identifiers 2

IdentifierTypeStateIssuer
0017374600009MedicaidPA
3906370OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • PATHMARK PHARMACY Doing business as

National Provider Directory

National Provider Directory
Part of
Great Atlantic Pacific Tea Company Inc

Locations

1000 Easton Rd
Ste 100
Wyncote, PA 19095
Phone (215) 572-7440

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1303430400000",
    "number": "1306943170",
    "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": "1000 EASTON RD 100",
            "city": "WYNCOTE",
            "state": "PA",
            "postal_code": "190952918",
            "telephone_number": "215-572-7440",
            "fax_number": "215-572-7893"
        }
    ],
    "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": "2011-04-22",
        "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": "PP413033L",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "PA",
            "license": "PP413033L",
            "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": "0017374600009",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3906370",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PATHMARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wyncote, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.