Organization
COLLINS FAMILY MARKETS, INC.
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
5675 N FRONT ST, PHILADELPHIA, PA 19120
(215) 224-7505
(215) 224-8329
Mailing address
5675 N FRONT ST, PHILADELPHIA, PA 19120
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP414003L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001112638
—
PA
01
—
259531
MASS IMMUNIZATION PTAN
—
01
—
3955208
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/20/2006
Last updated
01/14/2013
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