Union Lake Supermarket LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

UNION LAKE SUPERMARKET LLC

Practice address

2130 N 2ND St
Millville, NJ 08332-1304

Phone

(856) 327-9950

Fax

(856) 776-2313

NPI assigned

Jul 23, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Melissa Figueroa-Rivera

Title

Third Party Administrator

Phone

(732) 521-8439

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ShopRite Pharmacy Dept Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael F Purzycki

  • Pharmacist
  • Millville, NJ
  • NPI 1427654433
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322697600000",
    "number": "1154521664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2130 N 2ND ST",
            "city": "MILLVILLE",
            "state": "NJ",
            "postal_code": "083321304",
            "telephone_number": "856-327-9950",
            "fax_number": "856-776-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 N 2ND ST",
            "city": "MILLVILLE",
            "state": "NJ",
            "postal_code": "083321304",
            "telephone_number": "856-327-9950",
            "fax_number": "856-776-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNION LAKE SUPERMARKET LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-23",
        "last_updated": "2011-12-01",
        "status": "A",
        "authorized_official_last_name": "FIGUEROA-RIVERA",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "THIRD PARTY ADMINISTRATOR",
        "authorized_official_telephone_number": "732-521-8439"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0208965",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShopRite Pharmacy Dept",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tri-County Home and Hospice Care,LLC
• Michele Michael Tucker, HIGH SCHOOL DIPLOMA
• Ebony Turner
• Melvin Turner Jr.
• Jill K Tyler, RN APN-C
• Leigh Ann Upshaw
• Valmar Surgical Supplies Inc
• Village Drive Healthcare Urban Renewal LLC
• Voca Corporation of New Jersey
• Wal-Mart Stores East LP

• All providers in Millville, NJ
• Community/Retail Pharmacy in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.