Organization
FIVE STAR SUPERMARKETS OF NEW LONDON INC
Active
Other names
SHOP RITE PHARMACY OF NEW LONDON
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEORA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
351 N FRONTAGE RD, NEW LONDON, CT 06320-2628
(860) 447-1194
(860) 444-9474
Mailing address
PO BOX 15169, NEWARK, NJ 07192-5169
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PCY0001743
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004199966
—
CT
01
—
2002355
PK
—
Enumeration date
10/12/2006
Last updated
01/08/2015
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