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General NPI Number Information
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NPI Number | 1184739963
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Entity Type | Organization
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Legal Business Name | GLB SHOP ASSOCIATES LLC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 1409 BROAD ST
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-3001
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Country | US
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Telephone | 973-338-4143
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Fax | 973-893-1623
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Provider Business Mailing Address
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Address Line | 1409 BROAD ST
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-3001
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Country | US
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Telephone | 973-338-4143
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Fax | 973-893-1623
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00571800
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License Number State | NJ
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