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	333600000X	Pharmacy	L247	RI
2	3336C0003X	Community/Retail Pharmacy

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	4105335	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1902838865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE STOP & SHOP SUPERMARKET COMPANY LLC

Provider Business Mailing Address
First Line	:	1128 MINERAL SPRING AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-4104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1128 MINERAL SPRING AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-4104
Country	:	US
Telephone Number	:	401-727-3900
Fax Number	:	401-727-4076

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	08/26/2025

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

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