Healthcare Provider Details

I. General information

NPI: 1013007095
Provider Name (Legal Business Name): BIG Y FOODS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 POQUONNOCK ROAD
GROTON CT
06340
US

IV. Provider business mailing address

995 POQUONNOCK ROAD
GROTON CT
06340
US

V. Phone/Fax

Practice location:
  • Phone: 860-445-7719
  • Fax: 860-448-3145
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4259010021
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPCY1203
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GEORGE PAPPAS
Title or Position: PHARMACY OPERATIONS MANAGER
Credential:
Phone: 413-504-4492