Organization
UNION LAKE SUPERMARKET LLC
Active
Other names
ShopRite Pharmacy Dept
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA-RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
2130 N 2ND ST, MILLVILLE, NJ 08332-1304
(856) 327-9950
(856) 776-2313
Mailing address
2130 N 2ND ST, MILLVILLE, NJ 08332-1304
(856) 327-9950
(856) 776-2313
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0208965
—
NJ
Enumeration date
07/23/2007
Last updated
12/01/2011
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