=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972784213
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOPS MARKETS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2007
-----------------------------------------------------
Last Update Date | 07/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12775 BROADWAY ST
-----------------------------------------------------
City | ALDEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14004-9569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-937-6316
-----------------------------------------------------
Fax | 855-331-9046
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1027
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14240-1027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-635-5276
-----------------------------------------------------
Fax | 716-635-5992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | MATT HAMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-635-5274
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 024493
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------