1457660979 NPI number — BIG Y FOODS, INC

Table of content: (NPI 1457660979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457660979 NPI number — BIG Y FOODS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIG Y FOODS, 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:
BIG Y PHARMACY #32
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:
1457660979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2145 ROOSEVELT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01104-1650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-504-4492
Provider Business Mailing Address Fax Number:
413-504-4492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 BRIDGE ST
Provider Second Line Business Practice Location Address:
ATTN: PHARMACY DEPT.
Provider Business Practice Location Address City Name:
NAUGATUCK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06770-2812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-723-1876
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PAPPAS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
SR MANAGER OF PHARMACY SERVICES
Authorized Official Telephone Number:
413-504-4492

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  4259010042 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PCY.1374 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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