Healthcare Provider Details

I. General information

NPI: 1336171222
Provider Name (Legal Business Name): THE STOP & SHOP SUPERMARKET COMPNAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

815 GRAND ARMY HWY
SOMERSET MA
02726-1204
US

IV. Provider business mailing address

815 GRAND ARMY HWY
SOMERSET MA
02726-1204
US

V. Phone/Fax

Practice location:
  • Phone: 508-324-9693
  • Fax: 508-679-1276
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number3322
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number3322
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3322
License Number StateMA

VIII. Authorized Official

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