Provider Demographics
NPI:1245421890
Name:SUPER FRESH FOOD MARKETS, INC.
Entity Type:Organization
Organization Name:SUPER FRESH FOOD MARKETS, INC.
Other - Org Name:SUPER FRESH PHARMACY # 982
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KIJOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-571-8326
Mailing Address - Street 1:7162 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3250
Mailing Address - Country:US
Mailing Address - Phone:215-508-7782
Mailing Address - Fax:215-508-7785
Practice Address - Street 1:7162 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3250
Practice Address - Country:US
Practice Address - Phone:215-508-7782
Practice Address - Fax:215-508-7785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-08
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481751332B00000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3988877OtherNCPDP #
PA8970982OtherGROUP, DIV., STORE #
PA8970982OtherGROUP, DIV., STORE #