Organization
NUTLEY PARK SHOP RITE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEORA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8448
Entity
Organization
Contact information
Practice address
437 FRANKLIN AVE, NUTLEY, NJ 07110-2309
(973) 235-0821
(973) 667-5835
Mailing address
PO BOX 15169, NEWARK, NJ 07192-5169
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00286400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3122013
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
4322509
—
NJ
Enumeration date
08/20/2006
Last updated
11/14/2017
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