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NPI Code Detail

MEDICARE: STOP AND SHOP SUPERMARKET CO LLC

MEDICARE: STOP AND SHOP SUPERMARKET CO 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
1333600000XPharmacyL11RI
2332B00000XDurable Medical Equipment & Medical SuppliesL11RI
33336C0003XCommunity/Retail PharmacyL11RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14104054OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386676245
Entity Type Code : Organization
Provider Name (Legal Business Name) : STOP AND SHOP SUPERMARKET CO LLC
Provider Business Mailing Address
First Line : 1360 W MAIN RD
Second Line :
City : MIDDLETOWN
State : RI
Zip : 02842-6301
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1360 W MAIN RD
Second Line :
City : MIDDLETOWN
State : RI
Zip : 02842-6301
Country : US
Telephone Number : 401-849-9640
Fax Number : 401-849-8048
Authorized Official
Title or Position : DIRECTOR
Name : BRAD DAYTON
Credential :
Telephone Number : 617-770-8782
Provider Enumeration Date : 07/07/2006
Last Update Date : 10/24/2011

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Directions to “STOP AND SHOP SUPERMARKET CO LLC ” Practice Location

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