Provider Demographics
NPI:1538359781
Name:SICKLERVILLE SHOPRITE, INC
Entity type:Organization
Organization Name:SICKLERVILLE SHOPRITE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THIRD PARTY ADMINSTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-521-8439
Mailing Address - Street 1:1230 BLACKWOOD CLEMENTON RD
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-5632
Mailing Address - Country:US
Mailing Address - Phone:856-262-0902
Mailing Address - Fax:856-262-3190
Practice Address - Street 1:542 BERLIN-CROSS KEYS ROAD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081
Practice Address - Country:US
Practice Address - Phone:856-262-0902
Practice Address - Fax:856-262-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3194608OtherNCPDP
NJ6031850001Medicare NSC