Organization
SHOPRITE OF COMMACK LLC
Active
Other names
Shoprite of Commack LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
1 GARET PL, COMMACK, NY 11725-5420
(631) 864-0828
(631) 864-0874
Mailing address
PO BOX 15169, NEWARK, NJ 07192-5169
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
030473
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2127723
PK
—
05
—
3305777
—
NY
Enumeration date
11/09/2010
Last updated
04/28/2017
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