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General NPI Number Information
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NPI Number | 1184728313
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Entity Type | Organization
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Legal Business Name | BRACEYS SUPERMARKET INC.
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | ROUTE 502
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City | DALEVILLE
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State | PA
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Zip | 18444
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Country | US
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Telephone | 570-842-7848
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Fax | 570-842-2435
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Provider Business Mailing Address
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Address Line | 921 DRINKER TPKE
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City | COVINGTON TOWNSHIP
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State | PA
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Zip | 18444-7947
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Country | US
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Telephone | 570-842-7461
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Fax | 570-842-6520
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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 | PP415521L
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License Number State | PA
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