MEDICARE: SHOPRITE SUPERMARKETS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	025417	NY
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3325974	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417062290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHOPRITE SUPERMARKETS, INC

Provider Business Mailing Address
First Line	:	PO BOX 29010
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-9010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	178 ROUTE 52
Second Line	:
City	:	CARMEL
State	:	NY
Zip	:	10512-1200
Country	:	US
Telephone Number	:	914-225-1038
Fax Number	:	845-228-0257

Authorized Official
Title or Position	:	THIRD PARTY ADMINISTRATOR
Name	:	MELISSA FIGUEROA RIVERA
Credential	:
Telephone Number	:	732-521-8439

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/14/2010

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Directions to “SHOPRITE SUPERMARKETS, INC ” Practice Location

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