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General NPI Number Information
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NPI Number | 1104965771
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Entity Type | Organization
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Legal Business Name | SHOPRITE SUPERMARKETS, INC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 3140 E MAIN ST STE 300
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City | MOHEGAN LAKE
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State | NY
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Zip | 10547
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Country | US
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Telephone | 914-739-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 3140 E MAIN ST STE 300
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City | MOHEGAN LAKE
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State | NY
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Zip | 10547-1517
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Country | US
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Telephone | 914-739-7474
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Fax |
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Authorized Official
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Title or Position | THIRD PARTY ADMINISTRATOR
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Name | MELISSA FIGUEROA RIVERA
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Credential |
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Telephone | 732-521-8439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 025414
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License Number State | NY
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