Provider Demographics
NPI:1669404521
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:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-635-5274
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-1027
Mailing Address - Country:US
Mailing Address - Phone:716-635-5276
Mailing Address - Fax:716-635-5992
Practice Address - Street 1:271 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1613
Practice Address - Country:US
Practice Address - Phone:845-255-3344
Practice Address - Fax:844-411-6385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0349313336C0003X
NY0272103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163636OtherPK
3343504OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY02671305Medicaid