Provider Demographics
NPI:1154501906
Name:FOOD CIRCUS SUPERMARKET
Entity Type:Organization
Organization Name:FOOD CIRCUS SUPERMARKET
Other - Org Name:SUPER FOOD TOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF PHCY OPER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-380-7886
Mailing Address - Street 1:179 NEWMAN SPRINGS RD E
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:179 NEWMAN SPRINGS RD E
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4032
Practice Address - Country:US
Practice Address - Phone:732-212-0217
Practice Address - Fax:732-212-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3194800OtherOTHER ID NUMBER