Healthcare Provider Details

I. General information

NPI: 1053451260
Provider Name (Legal Business Name): TOPS MARKETS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 11/01/2016
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

PO BOX 1027
BUFFALO NY
14240-1027
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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number034932
License Number StateNY

VIII. Authorized Official

Name: JUSTIN NEAL
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 716-635-5274