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General NPI Number Information
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NPI Number | 1376688655
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Entity Type | Organization
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Legal Business Name | BIG Y FOODS, INC.
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 81 STONY HILL ROAD
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City | BETHEL
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State | CT
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Zip | 06801
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Country | US
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Telephone | 203-791-9820
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Fax | 203-791-8589
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Provider Business Mailing Address
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Address Line | 2145 ROOSEVELT AVE
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City | SPRINGFIELD
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State | MA
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Zip | 01104-1650
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Country | US
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Telephone | 141-350-4449
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Fax |
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Authorized Official
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Title or Position | VP, ASSISTANT SECRETARY
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Name | MR. MICHAEL S GOLD
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Credential |
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Telephone | 14135044492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PCY.2078
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PENDING
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License Number State | CT
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