Organization
4977, LLC
Active
Other names
SHOPRITE PHARMACY UPPER DEERFIELD
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
1000 N PEARL ST, BRIDGETON, NJ 08302-1215
(856) 453-5993
(856) 453-8631
Mailing address
1000 N PEARL ST, BRIDGETON, NJ 08302-1215
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
RS005859
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3142217
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
8611602
—
NJ
Enumeration date
08/20/2006
Last updated
08/10/2012
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