Healthcare Provider Details

I. General information

NPI: 1538184189
Provider Name (Legal Business Name): SUPER FRESH FOOD MARKETS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMERCE CIR
BRISTOL PA
19007-3114
US

IV. Provider business mailing address

300 COMMERCE CIR
BRISTOL PA
19007-3114
US

V. Phone/Fax

Practice location:
  • Phone: 215-785-5805
  • Fax: 215-826-9211
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPP414056L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP414056L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUSAN KIJOWSKI
Title or Position: PHARMACY SPECIALIST
Credential:
Phone: 201-571-8326