NPIMap

Organization Active NPI

Kleins Broadway & Main Inc

Doing business as Klein's Shoprite Pharmacy #547

  • Community/Retail Pharmacy
  • Bel Air, MD
National Provider Identifier
1952418147
Registry record updated Aug 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
P01415 Issued in MD
Legal business name
KLEINS BROADWAY & MAIN INC
Doing business as
Klein's Shoprite Pharmacy #547
Practice address
223 N Main St
Bel Air, MD 21014-3501
Phone
(410) 630-0600
Fax
(410) 638-6469
NPI assigned
Aug 24, 2006
Last updated
Aug 26, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2009

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

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X P01415 MD Primary

Addresses

Primary practice location

223 N Main St
Bel Air, MD 21014-3501

Mailing address

223 N Main St
Bel Air, MD 21014-3501
Phone (410) 630-0600

Other identifiers 2

IdentifierTypeStateIssuer
528282900MedicaidMD
2116538OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Klein's Shoprite Pharmacy #547 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930086563 MD DME Supplier - PharmacyDME Supplier - Grocery Store 2567581747 Practice locations: Bel Air, MD
O20120220000044 MD Part B Supplier - Mass Immunization (Roster Biller Only) 2567581747 Practice locations: Bel Air, MD

National Provider Directory

National Provider Directory
Tax ID family
Kleins Broadway Main Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

223 N Main St
Bel Air, MD 21014
Phone (410) 420-8224

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251244800000",
    "number": "1952418147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 N MAIN ST",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210143501",
            "telephone_number": "410-630-0600",
            "fax_number": "410-638-6469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 N MAIN ST",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210143501",
            "telephone_number": "410-630-0600",
            "fax_number": "410-638-6469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KLEINS BROADWAY & MAIN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2009-08-26",
        "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": "MD",
            "license": "P01415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528282900",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2116538",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Klein's Shoprite Pharmacy #547",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bel Air, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2009; 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.