Organization
BUONADONNA SHOPRITE LLC
Active
Other names
SHOPRITE OF BAYSHORE
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
1905 SUNRISE HWY, BAY SHORE, NY 11706-6017
(631) 666-9377
(631) 666-9330
Mailing address
PO BOX 15169, NEWARK, NJ 07192-5169
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
026563
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02534343
—
NY
01
—
3335456
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/20/2006
Last updated
10/05/2012
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