Healthcare Provider Details

I. General information

NPI: 1255446035
Provider Name (Legal Business Name): SAKER SHOPRITES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 1 OLD POST RD
EDISON NJ
08817
US

IV. Provider business mailing address

RT 1 OLD POST RD
EDISON NJ
08817
US

V. Phone/Fax

Practice location:
  • Phone: 732-819-8573
  • Fax: 732-819-8390
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRS04242
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9093907
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier9093915
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMEDICAID DME
# 3
Identifier3145162
Identifier TypeOTHER
Identifier State
Identifier IssuerOTHER ID NUMBER-COMMERCIAL NUMBER

VIII. Authorized Official

Name: MELISSA FIGUEROA RIVERA
Title or Position: THIRD PARTY ADMINISTRATOR
Credential:
Phone: 732-521-8448