Organization
KLEINS OF JACKSONVILLE INC
Active
Organization
KLEINS OF JACKSONVILLE INC
Active
Other names
Klein's Shoprite Pharmacy #563
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
14330 JARRETTSVILLE PIKE, PHOENIX, MD 21131-1743
(410) 666-1700
(410) 420-8228
Mailing address
14330 JARRETTSVILLE PIKE, PHOENIX, MD 21131-1743
(410) 666-1700
(410) 420-8228
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
P04081
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001843100
—
MD
01
—
2127581
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/24/2006
Last updated
07/21/2011
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