Provider Demographics
NPI:1457660979
Name:BIG Y FOODS, INC
Entity Type:Organization
Organization Name:BIG Y FOODS, INC
Other - Org Name:BIG Y PHARMACY #32
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR MANAGER OF PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
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:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-1650
Mailing Address - Country:US
Mailing Address - Phone:413-504-4492
Mailing Address - Fax:413-504-4492
Practice Address - Street 1:85 BRIDGE ST
Practice Address - Street 2:ATTN: PHARMACY DEPT.
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-2812
Practice Address - Country:US
Practice Address - Phone:203-723-1876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4259010042332B00000X
CTPCY.13743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4259010042Medicare NSC