Organization
BROWNS IA LLC
Active
Other names
SHOPRITE PHARMACY OF ISLAND AVE
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
2946 ISLAND AVE, PHILADELPHIA, PA 19153-2026
(215) 937-0327
(215) 492-1835
Mailing address
PO BOX 15169, NEWARK, NJ 07192
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP481371
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1010215360001
—
PA
01
—
3983283
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/20/2006
Last updated
07/13/2017
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