1477751675 NPI number — THE GREAT ATLANTIC & PACIFIC TEA CO., INC.

Table of content: (NPI 1477751675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477751675 NPI number — THE GREAT ATLANTIC & PACIFIC TEA CO., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LIVE BETTER PHARMACY # 441
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477751675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 OLD TAPPAN ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLD TAPPAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-391-0639
Provider Business Mailing Address Fax Number:
201-391-1845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 OLD TAPPAN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLD TAPPAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-391-0639
Provider Business Practice Location Address Fax Number:
201-391-1845
Provider Enumeration Date:
07/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIJOWSKI
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PHARMACY SPECIALIST
Authorized Official Telephone Number:
201-571-8326

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  06711 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 06711 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336M0002X , with the licence number: RS00671100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D09109200 . This is a "NJ STATE CDS LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: RS00671100 . This is a "NJ STATE PHARMACY LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3194470 . This is a "NCPDP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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