Provider Demographics
NPI:1922551886
Name:BIG Y FOODS, INC.
Entity Type:Organization
Organization Name:BIG Y FOODS, INC.
Other - Org Name:BIG Y PHARMACY #101
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR MANAGER OF PHARMACY SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
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:
Practice Address - Street 1:182 SUMMER ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1277
Practice Address - Country:US
Practice Address - Phone:781-585-1326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS34043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110020647YMedicaid
MA110020647YMedicaid