Organization
SHOPRITE OF WATERBURY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
943 WOLCOTT ST, WATERBURY, CT 06705-1301
(203) 753-1718
(203) 757-2095
Mailing address
943 WOLCOTT ST, WATERBURY, CT 06705-1301
(203) 753-1718
(203) 757-2095
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PCY1125
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004032199
—
CT
01
—
0709204
NCPDP
CT
Enumeration date
02/08/2007
Last updated
01/05/2012
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