Provider Demographics
NPI:1326353384
Name:THE STOP & SHOP SUPERMARKET COMPANY LLC
Entity Type:Organization
Organization Name:THE STOP & SHOP SUPERMARKET COMPANY LLC
Other - Org Name:STOP & SHOP PHARMACY #566
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR THIRD PARTY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-770-6257
Mailing Address - Street 1:7020 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1272
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7020 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1272
Practice Address - Country:US
Practice Address - Phone:617-770-6257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030351332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5800974OtherNCPDP
NY03271698Medicaid
NY5800974OtherNCPDP