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NPI Code Detail

MEDICARE: GRADE A SHOPRITE OF SOUTHBURY LLC

MEDICARE: GRADE A SHOPRITE OF SOUTHBURY LLC
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
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyPCY0002168CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22124367OTHERPK

General Provider Information

NPI Number : 1588987515
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRADE A SHOPRITE OF SOUTHBURY LLC
Provider Business Mailing Address
First Line : PO BOX 15169
Second Line :
City : NEWARK
State : NJ
Zip : 07192-5169
Country : US
Telephone Number : 203-267-7422
Fax Number :
Provider Business Practice Location Address
First Line : 775 MAIN ST S
Second Line :
City : SOUTHBURY
State : CT
Zip : 06488-2271
Country : US
Telephone Number : 203-267-7422
Fax Number : 203-267-7454
Authorized Official
Title or Position : THIRD PARTY ADMINISTRATOR
Name : MELISSA FIGUEROA RIVERA
Credential :
Telephone Number : 732-521-8439
Provider Enumeration Date : 03/04/2010
Last Update Date : 09/19/2025

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Directions to “GRADE A SHOPRITE OF SOUTHBURY LLC ” Practice Location

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