Provider Demographics
NPI:1730447301
Name:BIG Y FOODS, INC
Entity type:Organization
Organization Name:BIG Y FOODS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:JR
Authorized Official - Credentials:
Authorized Official - Phone:413-504-4492
Mailing Address - Street 1:700 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-2142
Mailing Address - Country:US
Mailing Address - Phone:413-528-5460
Mailing Address - Fax:413-528-5588
Practice Address - Street 1:700 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-2142
Practice Address - Country:US
Practice Address - Phone:413-528-5460
Practice Address - Fax:413-528-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110020647VMedicaid
MA4259010043Medicare NSC