MEDICARE: THE GREAT ATLANTIC AND PACIFIC TEA COMPANY 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	1854RC	LA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1920493	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972528529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC

Provider Business Mailing Address
First Line	:	14485 GREENWELL SPRINGS RD
Second Line	:
City	:	GREENWELL SPRINGS
State	:	LA
Zip	:	70739-3311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14485 GREENWELL SPRINGS RD
Second Line	:
City	:	GREENWELL SPRINGS
State	:	LA
Zip	:	70739-3311
Country	:	US
Telephone Number	:	225-261-7386
Fax Number	:	225-261-8227

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	:	09/11/2025

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Directions to “THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC ” Practice Location

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