Healthcare Provider Details

I. General information

NPI: 1063961753
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: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6734 ROUTE 9
RHINEBECK NY
12572-3724
US

IV. Provider business mailing address

PO BOX 1027
BUFFALO NY
14240-1027
US

V. Phone/Fax

Practice location:
  • Phone: 845-876-3202
  • Fax: 844-411-6392
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 Number034934
License Number StateNY

VIII. Authorized Official

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