Healthcare Provider Details

I. General information

NPI: 1295284982
Provider Name (Legal Business Name): TOPS MARKETS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 JON J WAGNER WAY
LAGRANGEVILLE NY
12540-5062
US

IV. Provider business mailing address

P.O. BOX 1027
BUFFALO NY
14240
US

V. Phone/Fax

Practice location:
  • Phone: 845-473-0459
  • Fax: 855-263-0227
Mailing address:
  • Phone: 716-635-5276
  • Fax: 716-635-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number034932
License Number StateNY

VIII. Authorized Official

Name: MATT HAMED
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 716-635-5274