Healthcare Provider Details

I. General information

NPI: 1821020710
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: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 FRANKLIN ST
BLOOMFIELD NJ
07003-5785
US

IV. Provider business mailing address

8 FRANKLIN ST
BLOOMFIELD NJ
07003-5785
US

V. Phone/Fax

Practice location:
  • Phone: 973-743-9218
  • Fax: 973-743-9241
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5935
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5935
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5935
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier8521204
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier3142825
Identifier TypeOTHER
Identifier State
Identifier IssuerOTHER ID NUMBER-COMMERCIAL NUMBER

VIII. Authorized Official

Name: ROGER WHEELER
Title or Position: PRESIDENT
Credential:
Phone: 207-885-2911