Organization
INSERRA SUPERMARKETS INC
Active
Other names
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
375 PATERSON AVE, WALLINGTON, NJ 07057-2101
(973) 471-7575
(973) 471-2198
Mailing address
PO BOX 781250, PHILADELPHIA, PA 19178-1250
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
RS004991
NJ
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0252395
—
NJ
01
—
0252689
MEDICAID DME
NJ
01
—
3135894
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/20/2006
Last updated
12/08/2015
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