Healthcare Provider Details

I. General information

NPI: 1932155959
Provider Name (Legal Business Name): SHAWS SUPERMARKETS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ALBANY TPKE # A
CANTON CT
06019-2547
US

IV. Provider business mailing address

110 ALBANY TPKE # A
CANTON CT
06019-2547
US

V. Phone/Fax

Practice location:
  • Phone: 860-693-9774
  • Fax: 860-693-3899
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1876
License Number StateCT

VIII. Authorized Official

Name: LORENZO TORRES
Title or Position: NEW STORE ENROLLMENTS
Credential:
Phone: 847-916-4463