Pathmark Stores Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

RS003807 Issued in NJ

Legal business name

PATHMARK STORES INC

Doing business as

Pathmark Pharmacy

Practice address

407 Valley St
South Orange, NJ 07079-2807

Phone

(973) 762-5044

Fax

(973) 378-3449

NPI assigned

Sep 20, 2006

Last updated

Dec 10, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

THE GREAT ATLANTIC & PACIFIC TEA COAs 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 3

Addresses

Other identifiers 2

Other names 1

• PATHMARK PHARMACY Doing business as

Part of

The Great Atlantic and

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Great Atlantic & Pacific Tea Company Inc

  dba A & P Pharmacy

  • Pharmacy
  • Allendale, NJ
  • NPI 1962427526

  Member Of

  NPD member

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228867200000",
    "number": "1568569325",
    "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": "407 VALLEY ST",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792807",
            "telephone_number": "973-762-5044",
            "fax_number": "973-378-3449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHMARK STORES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE GREAT ATLANTIC & PACIFIC TEA CO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-12-10",
        "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": "RS003807",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3102807",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4301005",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PATHMARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Pasquaicchio
• Dinesh R Patel, MD
• Nirali Patel
• Ramesh L Patel, MD
• Pathbold
• Patricia J. Parsons, PHD, PC
• Zelda Rae Patterson
• Jinu Elizabeth Paulose
• Jessica Elise Peccerelli
• Victor M. Petriella, D.M.D.

• Pharmacy in South Orange, NJ
• Providers in South Orange, NJ by specialty
• Pharmacy in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 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.