Organization
WAVERLY MARKETS, LLC
Active
Other names
ShopRite of Manchester/ 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
214 SPENCER ST, MANCHESTER, CT 06040-4618
(860) 645-3244
(860) 643-9283
Mailing address
PO BOX 15169, NEWARK, NJ 07192-5169
(860) 645-3240
(860) 645-3248
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PCY1083
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004194635
—
CT
01
—
0708391
NCPDP
CT
Enumeration date
02/08/2007
Last updated
10/03/2012
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