Provider Demographics
NPI:1578652103
Name:BIG Y FOODS INC
Entity Type:Organization
Organization Name:BIG Y FOODS INC
Other - Org Name:BIG Y PHARMACY #65
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OPERATIONS MANAGER
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 1:999 PROVIDENCE HWY
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-4232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:999 PROVIDENCE HWY
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-4232
Practice Address - Country:US
Practice Address - Phone:508-660-9713
Practice Address - Fax:508-660-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS3276333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2240288OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MA0404250Medicaid
2240288OtherOTHER ID NUMBER-COMMERCIAL NUMBER