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General NPI Number Information
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NPI Number | 1780799551
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Entity Type | Organization
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Legal Business Name | KEARNY SHOP-RITE INC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 12/19/2014
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Provider Practice Location Address
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Address Line | 100 PASSAIC AVE
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City | KEARNY
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State | NJ
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Zip | 07032-1140
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Country | US
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Telephone | 201-991-3568
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Fax | 201-991-4272
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Provider Business Mailing Address
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Address Line | PO BOX 15169
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City | NEWARK
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State | NJ
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Zip | 07192-5169
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Country | US
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Telephone | 201-991-3568
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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 | 372-521-8439
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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 | 28RS00239800
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License Number State | NJ
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