Organization
INSERRA SUPERMARKET INC
Active
Other names
Shoprite Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FIGUEROA RIVERA (THIRD PARTY ADMINISTRATOR)
(732) 521-8439
Entity
Organization
Contact information
Practice address
243 ROUTE 59, WEST NYACK, NY 10994-2036
(845) 353-4949
(845) 353-3993
Mailing address
PO BOX 21158, NEW YORK, NY 10087-1158
(845) 353-4949
(845) 353-3993
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
019616
NY
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01056862
—
NY
01
—
3390919
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/20/2006
Last updated
05/11/2017
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