MEDICARE: SHOPRITE OF PERRING PARKWAY 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
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1679843361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHOPRITE OF PERRING PARKWAY LLC

Provider Business Mailing Address
First Line	:	2401 CLEANLEIGH DR
Second Line	:
City	:	PARKVILLE
State	:	MD
Zip	:	21234-6808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 CLEANLEIGH DR
Second Line	:
City	:	PARKVILLE
State	:	MD
Zip	:	21234-6808
Country	:	US
Telephone Number	:	410-420-8224
Fax Number	:

Authorized Official
Title or Position	:	THIRD PARTY ADMINISTRATOR
Name	:	CAROLE HOJNOSKI
Credential	:
Telephone Number	:	732-521-8439

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	02/01/2012

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