Healthcare Provider Details

I. General information

NPI: 1891800678
Provider Name (Legal Business Name): VILLAGE SUPER MARKET OF NJ LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 S. WHITE HORSE PIKE SUITE C4
HAMMONTON NJ
08037
US

IV. Provider business mailing address

80 S. WHITE HORSE PIKE SUITE C4
HAMMONTON NJ
08037
US

V. Phone/Fax

Practice location:
  • Phone: 609-567-4275
  • 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
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License NumberRS006104
License Number StateNJ

VIII. Authorized Official

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