Healthcare Provider Details

I. General information

NPI: 1588611032
Provider Name (Legal Business Name): SHAWS SUPERMARKETS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ESSEX CENTER DR RT 114 128
PEABODY MA
01960
US

IV. Provider business mailing address

ESSEX CENTER DR RT 114 128
PEABODY MA
01960
US

V. Phone/Fax

Practice location:
  • Phone: 978-531-3951
  • Fax: 978-531-3970
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3297
License Number StateMA

VIII. Authorized Official

Name: MR. LORENZO TORRES III
Title or Position: NEW STORE ENROLLMENTS
Credential:
Phone: 847-916-4463