Organization
GRADE A SHOPRITE OF SOUTHBURY 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
775 MAIN ST S, SOUTHBURY, CT 06488-2271
(203) 267-7422
(203) 267-7454
Mailing address
PO BOX 15169, NEWARK, NJ 07192-5169
(203) 267-7422
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PCY0002168
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008017634
—
CT
01
—
2124367
PK
—
Enumeration date
03/04/2010
Last updated
09/19/2025
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