Organization
LML SUPERMARKETS INCORPORATED
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
201 ROOSEVELT PL, PALISADES PARK, NJ 07650-1152
(201) 461-2893
(201) 461-6501
Mailing address
PO BOX 8500-51250, PHILADELPHIA, PA 19178-0001
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
RS005616
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0252352
—
NJ
01
—
0252883
MEDICAID DME
NJ
01
—
3140100
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/20/2006
Last updated
02/16/2011
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