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General NPI Number Information
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NPI Number | 1396842167
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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 | 08/09/2007
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Provider Practice Location Address
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Address Line | 2506 KNIGHTS RD
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City | BENSALEM
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State | PA
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Zip | 19020-3400
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Country | US
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Telephone | 215-639-0100
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Fax | 215-639-3303
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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 | PP410975L
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License Number State | PA
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