Healthcare Provider Details

I. General information

NPI: 1962517748
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: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 TUCKAHOE RD
YONKERS NY
10710
US

IV. Provider business mailing address

PO BOX 29010
NEW YORK NY
10087-2901
US

V. Phone/Fax

Practice location:
  • Phone: 914-793-8300
  • Fax:
Mailing address:
  • Phone: 914-793-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number025413
License Number StateNY
# 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