Braceys Supermarket Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP415521L Issued in PA

Legal business name

BRACEYS SUPERMARKET INC.

Doing business as

Bill's ShopRite Pharmacy

Practice address

Route 502
Daleville, PA 18444

Phone

(570) 842-7848

Fax

(570) 842-2435

NPI assigned

Sep 8, 2006

Last updated

Mar 30, 2011By the provider in NPPES

Organization subpart

Yes

Parent organization

BRACEYS SUPERMARKET INCAs reported in NPPES

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 2

Other names 1

• Bill's ShopRite Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Bills Shursave Pharmacy

  • Community/Retail Pharmacy
  • Moscow, PA
  • NPI 1689619801

  O20100930024618

  Same enrollment

Part of

Braceys Supermarket Inc

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301443200000",
    "number": "1184728313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 DRINKER TPKE",
            "city": "COVINGTON TOWNSHIP",
            "state": "PA",
            "postal_code": "184447947",
            "telephone_number": "570-842-7461",
            "fax_number": "570-842-6520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ROUTE 502",
            "city": "DALEVILLE",
            "state": "PA",
            "postal_code": "18444",
            "telephone_number": "570-842-7848",
            "fax_number": "570-842-2435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRACEYS SUPERMARKET INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRACEYS SUPERMARKET INC",
        "enumeration_date": "2006-09-08",
        "last_updated": "2011-03-30",
        "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": "PA",
            "license": "PP415521L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3975743",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017474490001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bill's ShopRite Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.