MEDICARE: SHOP RITE OF HUNTERDON COUNTY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PP482563	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2150926	OTHER		PK

General Provider Information

NPI Number	:	1790178929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHOP RITE OF HUNTERDON COUNTY INC

Provider Business Mailing Address
First Line	:	PO BOX 15169
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07192-5169
Country	:	US
Telephone Number	:	908-454-7553
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 FREEMANSBURG AVE
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5529
Country	:	US
Telephone Number	:	610-865-2575
Fax Number	:	610-865-2913

Authorized Official
Title or Position	:	THIRD PARTY ADMINISTRATOR
Name	:	MELISSA FIGUEROA RIVERA
Credential	:
Telephone Number	:	732-521-8439

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	02/16/2017

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