Provider Demographics
NPI:1649517111
Name:TOPS MARKETS LLC
Entity type:Organization
Organization Name:TOPS MARKETS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-635-5274
Mailing Address - Street 1:P.O. BOX 1027
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240
Mailing Address - Country:US
Mailing Address - Phone:716-635-5276
Mailing Address - Fax:716-635-5992
Practice Address - Street 1:700 1ST NORTH ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-2180
Practice Address - Country:US
Practice Address - Phone:315-470-0988
Practice Address - Fax:855-331-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0317043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3845796Medicaid
2138408OtherPK
NY3845796Medicaid