Healthcare Provider Details

I. General information

NPI: 1922551886
Provider Name (Legal Business Name): BIG Y FOODS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 SUMMER ST
KINGSTON MA
02364-1277
US

IV. Provider business mailing address

2145 ROOSEVELT AVE
SPRINGFIELD MA
01104-1650
US

V. Phone/Fax

Practice location:
  • Phone: 781-585-1326
  • Fax:
Mailing address:
  • Phone: 413-504-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberDS3404
License Number StateMA

VIII. Authorized Official

Name: MR. GEORGE L PAPPAS
Title or Position: SR MANAGER OF PHARMACY SERVICES
Credential:
Phone: 413-504-4492