Organization
BROWNS FOX STREET LLC
Active
Organization
BROWNS FOX STREET LLC
Active
Other names
Shoprite Pharmacy #430
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
2800 FOX ST, UNIT A, PHILADELPHIA, PA 19129-1838
(215) 717-1422
(215) 717-1421
Mailing address
PO BOX 15169, NEWARK, NJ 07192-5169
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP482387
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141047
PK
—
Enumeration date
02/21/2013
Last updated
08/04/2015
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