Healthcare Provider Details

I. General information

NPI: 1194740654
Provider Name (Legal Business Name): GREAT ATLANTIC & PACIFIC TEA COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 ALBANY POST RD
CROTON ON HUDSON NY
10520-1573
US

IV. Provider business mailing address

PO BOX 416369
BOSTON MA
02241-6369
US

V. Phone/Fax

Practice location:
  • Phone: 914-271-0832
  • Fax: 914-271-0993
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number025546
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number025546
License Number StateNY

VIII. Authorized Official

Name: SUSAN KIJOWSKI
Title or Position: MANAGER, REGULATORY COMPLIANCE
Credential:
Phone: 201-571-8326