MEDICARE: TOPS MARKETS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	034933	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2164296	OTHER		PK

General Provider Information

NPI Number	:	1275082976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOPS MARKETS LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 1027
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14240
Country	:	US
Telephone Number	:	716-635-5276
Fax Number	:	716-635-5992

Provider Business Practice Location Address
First Line	:	1357 ROUTE 9
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-4420
Country	:	US
Telephone Number	:	845-298-7284
Fax Number	:	844-411-6419

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	MATT HAMED
Credential	:
Telephone Number	:	716-635-5274

Provider Enumeration Date	:	09/23/2016
Last Update Date	:	01/24/2018

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Directions to “TOPS MARKETS LLC ” Practice Location

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