Organization
MOUNT LAUREL SUPERMARKET 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
1000 NIXON DR, MOUNT LAUREL, NJ 08054-1171
(856) 439-1144
(856) 436-1348
Mailing address
1000 NIXON DR, MOUNT LAUREL, NJ 08054-1171
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
RS004934
NJ
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3135565
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
6241107
—
NJ
Enumeration date
08/20/2006
Last updated
11/20/2018
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