Healthcare Provider Details

I. General information

NPI: 1134154164
Provider Name (Legal Business Name): THE STOP & SHOP SUPERMARKET COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MARIANO BISHOP BLVD
FALL RIVER MA
02721-2349
US

IV. Provider business mailing address

333 MARIANO BISHOP BLVD
FALL RIVER MA
02721-2349
US

V. Phone/Fax

Practice location:
  • Phone: 508-675-0887
  • Fax: 508-675-0164
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number3381
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number3381
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3381
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0407241
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier2240896
Identifier TypeOTHER
Identifier State
Identifier IssuerOTHER ID NUMBER-COMMERCIAL NUMBER

VIII. Authorized Official

Name: ROGER WHEELER
Title or Position: PRESIDENT OF PHARMACY
Credential:
Phone: 207-885-2518