Healthcare Provider Details

I. General information

NPI: 1629903430
Provider Name (Legal Business Name): GRADE A MARKET OF SOUTH DANBURY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 NEWTOWN RD
DANBURY CT
06810-6254
US

IV. Provider business mailing address

PO BOX 15169
NEWARK NJ
07192-5169
US

V. Phone/Fax

Practice location:
  • Phone: 203-736-1055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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