Organization · NPI-2
Pathmark Stores INC
Pharmacy · Edgewater, NJ
NPI number1619074473
StatusActive
Last updated in NPPESDec 10, 2008
Details
- NPI
- 1619074473
- Entity type
- Organization (NPI-2)
- Legal business name
- Pathmark Stores INC
- Organization subpart
- Yes
- Enumeration date
- Sep 20, 2006
- Last updated
- Dec 10, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 333600000X | Pharmacy | RS005309 | NJ | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | RS2800325300 | NJ | |
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – |
Other names
- Pathmark Pharmacy (Doing Business As)
Practice location
481 River RdEdgewater, NJ 07020-1145
Phone 201-840-7764 · Fax 201-840-7786
Mailing address
2 Paragon DrMontvale, NJ 07645-1718
Phone 201-573-9700 · Fax 201-571-8335
Authorized official
Susan D Kijowski
Pharmacy Specialist
2015718326
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