Healthcare Provider Details

I. General information

NPI: 1942256565
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: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 STATE ROUTE 39
NEW FAIRFIELD CT
06812-4044
US

IV. Provider business mailing address

3030 CULLERTON ST
FRANKLIN PARK IL
60131-2205
US

V. Phone/Fax

Practice location:
  • Phone: 203-312-9818
  • Fax: 203-312-9830
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY0001860
License Number StateCT

VIII. Authorized Official

Name: DEMOND HAWKINS
Title or Position: THIRD PARTY MANAGER
Credential:
Phone: 208-395-3905