Organization Active NPI

Pathmark Stores Inc

Doing business as Pathmark Pharmacy

  • Community/Retail Pharmacy
  • Cherry Hill, NJ
National Provider Identifier
1407956436
Registry record updated Mar 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
PATHMARK STORES INC
Doing business as
Pathmark Pharmacy
Practice address
979 Church Rd
Cherry Hill, NJ 08002-1301
Phone
(856) 482-5120
Fax
(856) 482-6004
NPI assigned
Sep 22, 2006
Last updated
Mar 11, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA COAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 11, 2009

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 RS2800325300 NJ
Pharmacy 333600000X RS003322 NJ
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

979 Church Rd
Cherry Hill, NJ 08002-1301

Mailing address

2 Paragon Dr
Montvale, NJ 07645-1718
Phone (291) 573-9700

Other identifiers 2

IdentifierTypeStateIssuer
4342801MedicaidNJ
3124675OtherOTHER 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

979 Church Rd
Cherry Hill, NJ 08002
Phone (856) 482-5120

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236729600000",
    "number": "1407956436",
    "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": "291-573-9700",
            "fax_number": "201-571-8335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "979 CHURCH RD",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080021301",
            "telephone_number": "856-482-5120",
            "fax_number": "856-482-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHMARK STORES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE GREAT ATLANTIC & PACIFIC TEA CO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2009-03-11",
        "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": "NJ",
            "license": "RS2800325300",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NJ",
            "license": "RS003322",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4342801",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3124675",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PATHMARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cherry Hill, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2009; 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.