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	1793	CT
2	333600000X	Pharmacy	1793	CT
3	3336C0003X	Community/Retail Pharmacy	1793	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0719065	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831121706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE STOP & SHOP SUPERMARKET COMPANY LLC

Provider Business Mailing Address
First Line	:	120 SALMON BROOK ST
Second Line	:
City	:	GRANBY
State	:	CT
Zip	:	06035-2652
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 SALMON BROOK ST
Second Line	:
City	:	GRANBY
State	:	CT
Zip	:	06035-2604
Country	:	US
Telephone Number	:	860-844-8346
Fax Number	:	860-653-3210

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	02/10/2026

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