Provider Demographics
NPI:1720226376
Name:THE STOP & SHOP SUPERMARKET COMPANY LLC
Entity Type:Organization
Organization Name:THE STOP & SHOP SUPERMARKET COMPANY LLC
Other - Org Name:STOP & SHOP PHARMACY #2551
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-240-1526
Mailing Address - Street 1:194 W MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2306
Mailing Address - Country:US
Mailing Address - Phone:631-728-2627
Mailing Address - Fax:631-728-1579
Practice Address - Street 1:194 W MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2306
Practice Address - Country:US
Practice Address - Phone:631-728-2627
Practice Address - Fax:631-728-1579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03104423Medicaid
NY3360144OtherNCPDP
NY3360144OtherNCPDP