Organization
MANNIX FAMILY MARKET @ FOREST AND RICHMOND AVE LLC
Active
Other names
SHOPRITE PHARMACY OF FOREST AND RICHMOND
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
985 RICHMOND AVE, STATEN ISLAND, NY 10314-1501
(718) 982-8615
(718) 982-8633
Mailing address
985 RICHMOND AVE, STATEN ISLAND, NY 10314-1501
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
028451
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3354381
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/27/2007
Last updated
06/30/2015
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