Organization
GRADE A MARKET DERBY LLC
Active
Other names
SHOPRITE PHARMACY OF DERBY
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
49 PERSHING DR, DERBY, CT 06418-1406
(203) 736-1055
(203) 736-1007
Mailing address
PO BOX 15169, NEWARK, NJ 07192-5169
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PCY0001803
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004222923
—
CT
01
—
0719178
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/15/2007
Last updated
11/17/2017
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