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General NPI Number Information
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NPI Number | 1962685909
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Entity Type | Organization
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Legal Business Name | STOP & SHOP SUPERMARKET COMPANY LLC
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 12/28/2017
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Provider Practice Location Address
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Address Line | 999 MONTAUK HWY
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City | SHIRLEY
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State | NY
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Zip | 11967-2130
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Country | US
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Telephone | 631-281-3610
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Fax | 631-281-8924
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Provider Business Mailing Address
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Address Line | 999 MONTAUK HWY
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City | SHIRLEY
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State | NY
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Zip | 11967-2130
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Country | US
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Telephone | 631-281-3610
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Fax | 631-281-8924
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Authorized Official
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Title or Position | DIRECTOR PHARMACY SYSTEMS
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Name | BRAD DAYTON
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Credential |
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Telephone | 617-770-8782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Legacy Identifiers
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Identifier #1
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Identifier Code | 3357084
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Identifier Type | OTHER
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Identifier State | NY
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Identifier Issuer | NCPDP
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Identifier #2
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Identifier Code | 02949237
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Identifier Type | MEDICAID
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Identifier State | NY
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 02949237
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Identifier Type | MEDICAID
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Identifier State | NY
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Identifier Issuer |
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Identifier #2
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Identifier Code | 3357084
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Identifier Type | OTHER
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Identifier State | NY
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Identifier Issuer | NCPDP
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