MEDICARE: THE STOP & SHOP SUPERMARKET COMPANY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	5996	NJ
2	333600000X	Pharmacy	5996	NJ
3	3336C0003X	Community/Retail Pharmacy	5996	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3143219	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1194757047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE STOP & SHOP SUPERMARKET COMPANY LLC

Provider Business Mailing Address
First Line	:	353 ROUTE 37 E
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-5562
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	353 ROUTE 37 E
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-5562
Country	:	US
Telephone Number	:	732-341-3620
Fax Number	:	732-341-4863

Authorized Official
Title or Position	:	PRESIDENT OF PHARMACY
Name	:	ROGER WHEELER
Credential	:
Telephone Number	:	617-689-4130

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	03/11/2026

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Directions to “THE STOP & SHOP SUPERMARKET COMPANY LLC ” Practice Location

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