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NPI Code Detail

MEDICARE: PATHMARK STORES INC

MEDICARE: PATHMARK STORES 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
13336C0003XCommunity/Retail Pharmacy
2332B00000XDurable Medical Equipment & Medical SuppliesRS2800325300NJ
3333600000XPharmacyRS003253NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23124144OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1639276496
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATHMARK STORES INC
Provider Business Mailing Address
First Line : 2 PARAGON DR
Second Line :
City : MONTVALE
State : NJ
Zip : 07645-1718
Country : US
Telephone Number : 201-573-9700
Fax Number : 201-571-8335
Provider Business Practice Location Address
First Line : 4100 PARK AVE
Second Line :
City : WEEHAWKEN
State : NJ
Zip : 07086-6196
Country : US
Telephone Number : 201-867-0750
Fax Number : 201-422-9308
Authorized Official
Title or Position : PHARMACY SPECIALIST
Name : SUSAN D KIJOWSKI
Credential :
Telephone Number : 201-571-8326
Provider Enumeration Date : 09/20/2006
Last Update Date : 12/08/2008

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Directions to “PATHMARK STORES INC ” Practice Location

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