MEDICARE: THE STOP & SHOP SUPERMARKET COMPANY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	030351	NY
2	3336C0003X	Community/Retail Pharmacy	030351	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5800974	OTHER	NY	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326353384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE STOP & SHOP SUPERMARKET COMPANY LLC

Provider Business Mailing Address
First Line	:	7020 ROCKAWAY BEACH BLVD
Second Line	:
City	:	ARVERNE
State	:	NY
Zip	:	11692-1272
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7020 ROCKAWAY BEACH BLVD
Second Line	:
City	:	ARVERNE
State	:	NY
Zip	:	11692-1272
Country	:	US
Telephone Number	:	617-770-6257
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR THIRD PARTY
Name	:	ROBERT F STONE
Credential	:
Telephone Number	:	617-770-6257

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	12/20/2010

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Directions to “THE STOP & SHOP SUPERMARKET COMPANY LLC ” Practice Location

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