Organization
SHOPRITE OF GLEN BURNIE LLC
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
6716 RITCHIE HWY, GLEN BURNIE, MD 21061-2319
(443) 572-0604
(443) 572-0607
Mailing address
PO BOX 15169, NEWARK, NJ 07192-5169
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
P05386
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135437
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
441212500
—
MD
Enumeration date
07/27/2010
Last updated
08/17/2012
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