1225219579 NPI number — TOPS MARKETS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225219579 NPI number — TOPS MARKETS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOPS MARKETS LLC
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:
Provider Other Organization Name Type Code:
6
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:
1225219579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6914 ERIE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERBY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14047-9665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-947-4067
Provider Business Practice Location Address Fax Number:
855-331-9048
Provider Enumeration Date:
11/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAMED
Authorized Official First Name:
MATT
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
716-635-5274

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 024596 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2069910 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02040384 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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