Provider Demographics
NPI:1457307985
Name:SHAWS SUPERMARKETS INC
Entity Type:Organization
Organization Name:SHAWS SUPERMARKETS INC
Other - Org Name:OSCO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NEW STORE ENROLLMENTS
Authorized Official - Prefix:MR
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:847-916-4463
Mailing Address - Street 1:390 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:390 WEST ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1161
Practice Address - Country:US
Practice Address - Phone:508-339-5311
Practice Address - Fax:508-339-8931
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUPERVALU INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MA32813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0404292Medicaid
2240290OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0994260085Medicare NSC