NPIMap

Organization Active NPI

The Great Atlantic and Pacific Tea Company Inc

Doing business as Super Fresh Pharmacy

  • Pharmacy
  • Bowie, MD
National Provider Identifier
1396760948
Registry record updated Nov 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
P02519 Issued in MD
Legal business name
THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC
Doing business as
Super Fresh Pharmacy
Practice address
4825 Glenn Dale Rd
Bowie, MD 20720-3585
Phone
(301) 262-3647
Fax
(301) 262-5526
NPI assigned
Jul 13, 2006
Last updated
Nov 23, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan Kijowski
Title
Pharmacy Specialist
Phone
(201) 571-8326

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X P02519 MD
Pharmacy 333600000X P02519 MD Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

4825 Glenn Dale Rd
Bowie, MD 20720-3585

Mailing address

4825 Glenn Dale Rd
Bowie, MD 20720-3585

Other identifiers 1

IdentifierTypeStateIssuer
2124395OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • SUPER FRESH PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Great Atlantic Pacific Tea Company Inc32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

4825 Glenn Dale Rd
Bowie, MD 20720
Phone (301) 262-3647

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195776000000",
    "number": "1396760948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4825 GLENN DALE RD",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207203585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4825 GLENN DALE RD",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207203585",
            "telephone_number": "301-262-3647",
            "fax_number": "301-262-5526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2007-11-23",
        "status": "A",
        "authorized_official_last_name": "KIJOWSKI",
        "authorized_official_first_name": "SUSAN",
        "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": "MD",
            "license": "P02519",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MD",
            "license": "P02519",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2124395",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUPER FRESH PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2007; 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.