Organization
ACME MARKETS INC
Active
Parent organization
SUPERVALU INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUPERVALU INC
Authorized official
DEMOND HAWKINS (THIRD PARTY MANAGER)
(208) 395-3905
Entity
Organization
Contact information
Practice address
300 RYDERS LN, MILLTOWN, NJ 08850-1706
(732) 254-6760
(732) 254-8320
Mailing address
3030 CULLERTON ST, FRANKLIN PARK, IL 60131-2205
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RS05961
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3143093
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
8713103
—
NJ
Enumeration date
05/25/2006
Last updated
01/19/2018
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