Provider Demographics
NPI:1396850178
Name:SAKER SHOPRITES INC.
Entity Type:Organization
Organization Name:SAKER SHOPRITES INC.
Other - Org Name:SHOPRITE PHARMACY #522
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THIRD PARTY ADMINISTRATOR
Authorized Official - Prefix:
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 1:877 SAINT GEORGE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-2514
Mailing Address - Country:US
Mailing Address - Phone:732-636-4151
Mailing Address - Fax:732-636-7123
Practice Address - Street 1:877 SAINT GEORGE AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2514
Practice Address - Country:US
Practice Address - Phone:732-636-4151
Practice Address - Fax:732-636-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS004240333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3130414OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NJ4403207Medicaid
NJ4403215OtherMEDICAID DME
3130414OtherOTHER ID NUMBER-COMMERCIAL NUMBER