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General NPI Number Information
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NPI Number | 1821138025
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Entity Type | Organization
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Legal Business Name | VILLAGE SUPER MARKET OF NJ LP
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 641 SHUNPIKE RD/SOUTHERN BLVD SOUTHERN BLVD
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City | CHATHAM
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State | NJ
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Zip | 07928-1567
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Country | US
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Telephone | 973-377-5770
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Fax | 973-377-0676
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Provider Business Mailing Address
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Address Line | 641 SHUNPIKE RD SOUTHERN BLVD
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City | CHATHAM
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State | NJ
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Zip | 07920
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Country | US
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Telephone | 973-377-5770
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Fax | 973-377-0676
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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 | 732-521-8448
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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 | RS004005
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License Number State | NJ
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