Provider Demographics
NPI:1033224803
Name:SUNRISE SHOPRITE INC
Entity Type:Organization
Organization Name:SUNRISE SHOPRITE INC
Other - Org Name:SHOPRITE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-575-1770
Mailing Address - Street 1:540 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7449
Mailing Address - Country:US
Mailing Address - Phone:973-575-1770
Mailing Address - Fax:
Practice Address - Street 1:540 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7449
Practice Address - Country:US
Practice Address - Phone:973-575-0030
Practice Address - Fax:973-575-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS004102003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2057386OtherPK
NJ4321006Medicaid
NJ4321006Medicaid