MEDICARE: BIG Y FOODS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	DS3340	MA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2240644	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487743019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIG Y FOODS INC

Provider Business Mailing Address
First Line	:	200 WEST ST
Second Line	:
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-5735
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 WEST ST
Second Line	:
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-5735
Country	:	US
Telephone Number	:	413-447-9844
Fax Number	:	413-447-9041

Authorized Official
Title or Position	:	PHARMACY OPERATIONS MANAGER
Name	:	GEORGE PAPPAS
Credential	:
Telephone Number	:	413-504-4492

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	01/31/2008

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Directions to “BIG Y FOODS INC ” Practice Location

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