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General NPI Number Information
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NPI Number | 1053418814
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Entity Type | Organization
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Legal Business Name | PATHMARK STORES INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 2660 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10306-4355
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Country | US
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Telephone | 718-979-1005
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Fax | 718-980-5512
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Provider Business Mailing Address
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Address Line | 200 MILIK ST M115
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City | CARTERET
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State | NJ
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Zip | 07008-1102
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | MINDI NORELLI
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Credential |
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Telephone | 732-499-3313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 014471
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License Number State | NY
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