Organization
EVESHAM SUPERMARKET LLC
Active
Other names
Shop Rite Pharmacy Dept #529
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
400 EVESHAM RD, CHERRY HILL, NJ 08003-4010
(856) 216-0115
(856) 216-7190
Mailing address
PO BOX 15169, NEWARK, NJ 07192-5169
(856) 216-0115
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00673500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0154296
—
NJ
01
—
2056163
PK
—
Enumeration date
07/25/2007
Last updated
09/19/2025
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