Pathmark Stores Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

PP411790L Issued in PA

Legal business name

PATHMARK STORES INC

Practice address

500 Lincoln Hwy
Fairless Hills, PA 19030-1417

Phone

(215) 295-2834

Fax

(215) 295-0274

NPI assigned

Sep 20, 2006

Organization subpart

Yes

Parent organization

THE GREAT ATLANTIC & PACIFIC TEA CO., INC.As reported in NPPES

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 2

Addresses

Other identifiers 2

Other names 1

• PATHMARK PHARMACY Doing business as

Part of

Great Atlantic Pacific Tea Company Inc

Locations

Practitioners 2

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

• Ronald J Kitchenman, R.PH.

  • Pharmacist
  • Fairless Hills, PA
  • NPI 1003087255
  NPD (past)
• Dwight Molotsky

  • Pharmacist
  • Fairless Hills, PA
  • NPI 1609044650
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1497852263",
    "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": "500 LINCOLN HWY",
            "city": "FAIRLESS HILLS",
            "state": "PA",
            "postal_code": "190301417",
            "telephone_number": "215-295-2834",
            "fax_number": "215-295-0274"
        }
    ],
    "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": "2008-06-23",
        "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": "PP411790L",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "PA",
            "license": "PP411790L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017374600007",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3906368",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PATHMARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Yong I Park, MD
• Milissa Parker
• Chaitali J. Patel, PA-C
• Dharaben Patel, PHARMD
• Maunita Patel
• Patient Care Now, LLC
• Patient First Pennsylvania Medical Group
• Patient First Pennsylvania Medical Group PLLC
• George Pepe, DO
• Adam Matthew Phillips, LPC

• All providers in Fairless Hills, PA
• Pharmacy in Pennsylvania

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

Verify at the official NPI Registry.