Provider Demographics
NPI:1609027440
Name:BIG Y FOODS, INC.
Entity Type:Organization
Organization Name:BIG Y FOODS, INC.
Other - Org Name:BIG Y PHARMACY #56
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
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:413-504-5492
Practice Address - Street 1:1 KENT RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3405
Practice Address - Country:US
Practice Address - Phone:860-354-5554
Practice Address - Fax:860-350-8738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY.00018813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCY0001881OtherCT PHARMACY LICENSE
CTPCY0001881OtherCT PHARMACY LICENSE