PATHMARK STORES INC NPI 1205933074

NPI Information

  • NPI: 1205933074
  • Provider Name: PATHMARK STORES INC
  • Classification: Pharmacy - 333600000X
  • Entity Type: Organization
  • Doing Business As: PATHMARK PHARMACY
  • Address: 3021 GRAYS FERRY AVE
    PHILADELPHIA, PA
    ZIP 19146
  • Phone: (215) 551-7284

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NPI Details

PATHMARK STORES INC is a pharmacy in Philadelphia, PA. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. PATHMARK STORES INC NPI is 1205933074. The provider is registered as an organization entity type.
The provider Is Doing Business As Pathmark Pharmacy.

The provider's business location address is:

3021 GRAYS FERRY AVE
PHILADELPHIA, PA
ZIP 19146-709
Phone: (215) 551-7284
Fax: (215) 468-5218

The provider's authorized official is Susan D Kijowski .
The authorized official title is Pharmacy Specialist and has the following contact phone number (201) 571-8326.

The enumeration date for this NPI number is 9/20/2006 and was last updated on 6/27/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332B00000XDurable Medical Equipment & Medical SuppliesPP414226LPENNSYLVANIANo
23336C0003XPharmacyCommunity/Retail PharmacyNo
3333600000XPharmacyPP414226LPENNSYLVANIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10017374600010MEDICAIDPENNSYLVANIA
23958571OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
30636000016MEDICARE NSCPENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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