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Organization

SHOPRITE OF BRISTOL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization

Contact information

Practice address
1200 FARMINGTON AVE, BRISTOL, CT 06010-4714
(860) 584-5733
(860) 584-9668
Mailing address
1200 FARMINGTON AVE, BRISTOL, CT 06010-4714
(860) 584-5733
(860) 584-9668

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
3336C0003X
Community/Retail Pharmacy
Primary
PCY1700
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
004195956
CT
01
0718140
NCPDP
CT
Enumeration date
02/08/2007
Last updated
10/03/2012
About Stedi
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