Provider Demographics
NPI:1104293125
Name:ACME MARKETS INC
Entity type:Organization
Organization Name:ACME MARKETS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THIRD PARTY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-395-3905
Mailing Address - Street 1:3030 CULLERTON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2205
Mailing Address - Country:US
Mailing Address - Phone:914-271-0832
Mailing Address - Fax:914-271-0993
Practice Address - Street 1:2005 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-1573
Practice Address - Country:US
Practice Address - Phone:914-271-0832
Practice Address - Fax:914-271-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
APPLIED FOROtherNCPDP PROVIDER NUMBER