Healthcare Provider Details

I. General information

NPI: 1487977419
Provider Name (Legal Business Name): FIVE STAR SUPERMARKETS OF CLINTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 E MAIN ST
CLINTON CT
06413-2254
US

IV. Provider business mailing address

PO BOX 15169
NEWARK NJ
07192-5169
US

V. Phone/Fax

Practice location:
  • Phone: 860-669-6619
  • Fax: 860-669-1368
Mailing address:
  • Phone: 860-669-6619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY0002169
License Number StateCT

VIII. Authorized Official

Name: MELISSA FIGUEROA-RIVERA
Title or Position: THIRD PARTY ADMINISTRATOR
Credential:
Phone: 732-521-8439