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General NPI Number Information
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NPI Number | 1407961295
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Entity Type | Organization
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Legal Business Name | KTM SUPERMARKETS, INC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 1115 W CHESTER PIKE
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City | WEST CHESTER
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State | PA
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Zip | 19382-5065
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Country | US
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Telephone | 610-696-7561
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Fax | 610-429-0945
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Provider Business Mailing Address
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Address Line | 355 DAVIDSONS MILL RD
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City | JAMESBURG
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State | NJ
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Zip | 08831-3014
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Country | US
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Telephone |
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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 | 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 | PP415516L
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License Number State | PA
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