KTM II Supermarkets LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP482205 Issued in PA

Legal business name

KTM II SUPERMARKETS LLC

Practice address

170 Forty Foot Rd
Hatfield, PA 19440-2852

Phone

(215) 368-9323

Fax

(215) 368-9325

NPI assigned

Jul 25, 2011

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 2

Other names 1

• Shoprite Pharmacy of Hatfield Doing business as

Locations

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

{
    "created_epoch": "1311552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447632000000",
    "number": "1912285016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15169",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071925169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 FORTY FOOT RD",
            "city": "HATFIELD",
            "state": "PA",
            "postal_code": "194402852",
            "telephone_number": "215-368-9323",
            "fax_number": "215-368-9325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KTM II SUPERMARKETS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-25",
        "last_updated": "2015-11-16",
        "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": "PP482205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1026605040001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2131817",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shoprite Pharmacy of Hatfield",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joanne Kling, ED.D.
• Taylor Kohl
• Rajiv Kolandaivelu, D.M.D
• Diane Marie Kortz
• Susan Sommers Koster, CRNP
• Dylan Kummery, DPT
• Labstar Diagnostics LLC
• Ciena Diane Lavallee, PT, DPT
• Janet B Leidy, M.AC., L.AC.,
• Ethan Lizak, PT, DPT

• Community/Retail Pharmacy in Hatfield, PA
• Providers in Hatfield, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.