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General NPI Number Information
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NPI Number | 1477751675
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Entity Type | Organization
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Legal Business Name | THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 216 OLD TAPPAN ROAD
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City | OLD TAPPAN
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State | NJ
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Zip | 07675
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Country | US
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Telephone | 201-391-0639
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Fax | 201-391-1845
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Provider Business Mailing Address
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Address Line | 216 OLD TAPPAN ROAD
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City | OLD TAPPAN
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State | NJ
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Zip | 07675
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Country | US
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Telephone | 201-391-0639
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Fax | 201-391-1845
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Authorized Official
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Title or Position | PHARMACY SPECIALIST
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Name | MRS. SUSAN D KIJOWSKI
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Credential | BS
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Telephone | 201-571-8326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | RS00671100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 06711
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 06711
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License Number State | NJ
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