Healthcare Provider Details

I. General information

NPI: 1780618652
Provider Name (Legal Business Name): STOP AND SHOP SUPERMARKET CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 SPRINGFIELD ST
FEEDING HILLS MA
01030-2119
US

IV. Provider business mailing address

1282 SPRINGFIELD ST
FEEDING HILLS MA
01030-2119
US

V. Phone/Fax

Practice location:
  • Phone: 413-789-2226
  • Fax: 413-786-2422
Mailing address:
  • Phone: 413-789-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2299
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2299
License Number StateMA

VIII. Authorized Official

Name: BRAD DAYTON
Title or Position: DIRECTOR
Credential:
Phone: 617-770-8782