Healthcare Provider Details

I. General information

NPI: 1013949981
Provider Name (Legal Business Name): THE STOP & SHOP SUPERMARKET COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FRANKLIN ST
SEYMOUR CT
06483-2809
US

IV. Provider business mailing address

15 FRANKLIN ST
SEYMOUR CT
06483-2809
US

V. Phone/Fax

Practice location:
  • Phone: 203-881-2756
  • Fax: 203-881-0149
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1763
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1763
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1763
License Number StateCT

VIII. Authorized Official

Name: GORDON REID
Title or Position: DIRECTOR
Credential:
Phone: 207-885-2518