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Organization
INSERRA SUPERMARKET INC
Active
Organization
INSERRA SUPERMARKET INC
Active
Other names
Shoprite Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
243 ROUTE 59, WEST NYACK, NY 10994-2036
(845) 353-4949
(845) 353-3993
Mailing address
PO BOX 21158, NEW YORK, NY 10087-1158
(845) 353-4949
(845) 353-3993
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
019616
NY
3336C0003X
Community/Retail Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01056862
—
NY
01
—
3390919
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/20/2006
Last updated
05/11/2017
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