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General NPI Number Information
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NPI Number | 1992802755
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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 | 01/22/2009
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Provider Practice Location Address
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Address Line | 1933 STATE ROUTE 35
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City | WALL TOWNSHIP
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State | NJ
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Zip | 07719-3502
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Country | US
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Telephone | 732-449-8070
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Fax | 732-974-2734
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Provider Business Mailing Address
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Address Line | 2 PARAGON DR
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City | MONTVALE
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State | NJ
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Zip | 07645-1718
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Country | US
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Telephone | 201-571-8326
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Fax | 201-573-9700
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Authorized Official
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Title or Position | PHARMACY SPECIALIST
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Name | SUSAN D KIJOWSKI
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Credential |
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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 | 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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | RS28003959
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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 | RS003959
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License Number State | NJ
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