Healthcare Provider Details

I. General information

NPI: 1568577344
Provider Name (Legal Business Name): SHOPRITE SUPERMARKETS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 SUMMERHILL RD
SPOTSWOOD NJ
08884-1239
US

IV. Provider business mailing address

PO BOX 29010
NEW YORK NY
10087-9010
US

V. Phone/Fax

Practice location:
  • Phone: 732-251-5214
  • Fax: 732-251-9425
Mailing address:
  • Phone: 732-251-5214
  • Fax: 732-251-9425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number004799
License Number StateNJ
# 2
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