=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013057314
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONETCO SUPERMARKETS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 11/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 US HIGHWAY #23
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-827-1806
-----------------------------------------------------
Fax | 973-827-0949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1070 US HIGHWAY 46 STE 17
-----------------------------------------------------
City | LEDGEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07852-9701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-927-8300
-----------------------------------------------------
Fax | 973-927-4953
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THIRD PARTY ADMINISTRATOR
-----------------------------------------------------
Name | MELISSA FIGUEROA RIVERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-521-8448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | RS004898
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------