Healthcare Provider Details

I. General information

NPI: 1528381480
Provider Name (Legal Business Name): THE STOP & SHOP SUPERMARKET COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 RTE 39
NEW FAIRFIELD CT
06812
US

IV. Provider business mailing address

1149 HARRISBURG PIKE
CARLISLE PA
17013-1607
US

V. Phone/Fax

Practice location:
  • Phone: 203-312-9818
  • Fax:
Mailing address:
  • Phone: 717-240-5520
  • Fax: 717-960-8371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1860
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY 0001860
License Number StateCT

VIII. Authorized Official

Name: ALISON FARRELL
Title or Position: DIRECTOR
Credential:
Phone: 717-240-1526