Provider Demographics
NPI:1710027479
Name:TRIPUTI BROTHERS LLC
Entity Type:Organization
Organization Name:TRIPUTI BROTHERS LLC
Other - Org Name:SHOPSMART FOOD & PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:908-355-2400
Mailing Address - Street 1:570 N BROAD ST STE D
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-4301
Mailing Address - Country:US
Mailing Address - Phone:908-355-2400
Mailing Address - Fax:
Practice Address - Street 1:570 N BROAD ST STE D
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-4301
Practice Address - Country:US
Practice Address - Phone:908-355-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006458003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0062961Medicaid
NJ5376950001Medicare NSC