Organization
BRACEYS SUPERMARKET INC.
Active
Parent organization
BRACEYS SUPERMARKET INC
Other names
Bill's ShopRite Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
BRACEYS SUPERMARKET INC
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
ROUTE 502, DALEVILLE, PA 18444
(570) 842-7848
(570) 842-2435
Mailing address
921 DRINKER TPKE, COVINGTON TOWNSHIP, PA 18444-7947
(570) 842-7461
(570) 842-6520
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP415521L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017474490001
—
PA
01
—
3975743
NCPDP
PA
Enumeration date
09/08/2006
Last updated
03/30/2011
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