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NPI Code Detail

MEDICARE: SHAWS SUPERMARKETS INC

MEDICARE: SHAWS SUPERMARKETS INC
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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail PharmacyPCY0001957CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10720119OTHERNCPDP PROVIDER IDENTIFICATION NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841246865
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHAWS SUPERMARKETS INC
Provider Business Mailing Address
First Line : 3030 CULLERTON ST
Second Line :
City : FRANKLIN PARK
State : IL
Zip : 60131-2205
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 775 MAIN ST S
Second Line :
City : SOUTHBURY
State : CT
Zip : 06488-2271
Country : US
Telephone Number : 203-267-7422
Fax Number : 203-267-7454
Authorized Official
Title or Position : THIRD PARTY MANAGER
Name : DEMOND HAWKINS
Credential :
Telephone Number : 208-395-3905
Provider Enumeration Date : 05/25/2006
Last Update Date : 01/23/2018

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Directions to “SHAWS SUPERMARKETS INC ” Practice Location

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