Provider Demographics
NPI:1083185219
Name:BIG Y FOODS, INC.
Entity Type:Organization
Organization Name:BIG Y FOODS, INC.
Other - Org Name:BIG Y PHARMACY #109
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR MANAGER PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-504-4492
Mailing Address - Street 1:2145 ROOSEVELT AVE
Mailing Address - Street 2:ATTN PHARMACY DEPT
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:413-504-4492
Mailing Address - Fax:413-504-5492
Practice Address - Street 1:7 E HAMPTON RD
Practice Address - Street 2:RT 66
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1402
Practice Address - Country:US
Practice Address - Phone:860-467-9138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIG Y FOODS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-16
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCY.0002377OtherPHARMACY STATE LICENSE
CT008084481Medicaid