Organization
GRADE A SHOP RITE COMMERCE RD LLC
Active
Other names
Shoprite Pharmacy of Commerce Park
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
1990 W MAIN ST, STAMFORD, CT 06902-4563
(203) 978-0464
Mailing address
PO BOX 15169, NEWARK, NJ 07192-5169
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PCY2047
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0720551
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/17/2006
Last updated
10/04/2012
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