Organization
SHOPRITE OF GLEN BURNIE LLC
Active
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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