Organization
KTM 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
1115 W CHESTER PIKE, WEST CHESTER, PA 19382-5065
(610) 696-7561
(610) 429-0945
Mailing address
355 DAVIDSONS MILL RD, JAMESBURG, NJ 08831-3014
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP415516L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01739821
—
PA
01
—
3975464
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/20/2006
Last updated
12/14/2011
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