Organization
MANNIX FAMILY MARKET AT VETERANS ROAD LLC
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
3010 VETERANS RD W, STATEN ISLAND, NY 10309-2510
(718) 979-0718
Mailing address
PO BOX 15169, NEWARK, NJ 07192-5169
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
034048
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154797
PK
—
Enumeration date
10/06/2015
Last updated
02/16/2017
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