Provider Demographics
NPI:1437742624
Name:BRACEYS SUPERMARKET INC MOOSIC
Entity Type:Organization
Organization Name:BRACEYS SUPERMARKET INC MOOSIC
Other - Org Name:SHOPRITE PHARMACY OF BIRNEY AVENUE
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 1:921 DRINKER TPKE STE 24
Mailing Address - Street 2:
Mailing Address - City:COVINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-7948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3382 BIRNEY PLZ
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1560
Practice Address - Country:US
Practice Address - Phone:570-904-6042
Practice Address - Fax:570-904-6043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy