MEDICARE: TOPS MARKETS, LLC

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	3336C0003X	Community/Retail Pharmacy	034933	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2163637	OTHER		PK

General Provider Information

NPI Number	:	1588696447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOPS MARKETS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1027
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14240-1027
Country	:	US
Telephone Number	:	716-635-5276
Fax Number	:	716-635-5992

Provider Business Practice Location Address
First Line	:	1357 ROUTE 9
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-4420
Country	:	US
Telephone Number	:	845-298-7284
Fax Number	:	844-411-6419

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	JUSTIN NEAL
Credential	:
Telephone Number	:	716-635-5274

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	11/01/2016

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