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NPI Code Detail

MEDICARE: SUPER FRESH FOOD MARKETS INC

MEDICARE: SUPER FRESH FOOD MARKETS 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 SuppliesPP415673LPA
3333600000XPharmacyPP415673LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23977470OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1700801354
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPER FRESH FOOD MARKETS INC
Provider Business Mailing Address
First Line : 7700 CRITTENDEN ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19118-4421
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7700 CRITTENDEN ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19118-4421
Country : US
Telephone Number : 215-247-3900
Fax Number : 215-247-1061
Authorized Official
Title or Position : PHARMACY SPECIALIST
Name : SUSAN KIJOWSKI
Credential :
Telephone Number : 201-571-8326
Provider Enumeration Date : 07/13/2006
Last Update Date : 05/24/2009

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Directions to “SUPER FRESH FOOD MARKETS INC ” Practice Location

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