Basic Information
| Provider Information | |||||||||
| NPI: | 1689789455 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAKER SHOPRITES INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SHOPRITE PHARMACY DEPT #638 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CENTERVILLE RD | ||||||||
| Address2: | |||||||||
| City: | HOLMDEL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077331103 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1732 HIGHWAY 35 | ||||||||
| Address2: | |||||||||
| City: | WALL TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077193440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326810550 | ||||||||
| FaxNumber: | 7326815463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FIGUEROA RIVERA | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | THIRD PARTY ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7325218439 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 333600000X | RS002169 | NJ | Y | Suppliers | Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 4268806 | 05 | NJ | MEDICAID | 3116488 | 01 | OTHER ID NUMBER-COMMERCIAL NUMBER | OTHER | 4268814 | 01 | NJ | MEDICAID DME | OTHER |