Organization
LML SUPERMARKETS INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
500 S RIVER ST, HACKENSACK, NJ 07601-6651
(201) 329-7480
(201) 329-7493
Mailing address
PO BOX 781250, PHILADELPHIA, PA 19178-0001
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
RS004994
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0252344
—
NJ
01
—
0253421
MEDICAID DME
NJ
01
—
3136187
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/20/2006
Last updated
09/20/2016
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