Organization
INSERRA SUPERMARKETS INC.
Active
Other names
ShopRite Pharmacy of Lodi
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
175 MAIN STREET, LODI, NJ 07644
(973) 365-2289
(973) 365-0925
Mailing address
PO BOX 8500-51250, PHILADELPHIA, PA 19178-0001
(973) 365-2289
(973) 365-0925
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
RS003702
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3127241
NCPDP
NJ
05
—
4366301
—
NJ
01
—
4366310
MEDICAID DME
NJ
Enumeration date
02/02/2007
Last updated
08/03/2011
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