Healthcare Provider Details

I. General information

NPI: 1457525545
Provider Name (Legal Business Name): BIG Y FOODS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 WINSTED RD
TORRINGTON CT
06790
US

IV. Provider business mailing address

504 WINSTED RD
TORRINGTON CT
06790
US

V. Phone/Fax

Practice location:
  • Phone: 860-489-2970
  • Fax: 860-489-0246
Mailing address:
  • Phone: 860-489-2970
  • Fax: 860-489-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPCY.2109
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY.2109
License Number StateCT

VIII. Authorized Official

Name: MR. MICHAEL S GOLD
Title or Position: VP, ASSISTANT SECRETARY
Credential:
Phone: 413-504-4492