Provider Demographics
NPI:1962685909
Name:STOP & SHOP SUPERMARKET COMPANY LLC
Entity Type:Organization
Organization Name:STOP & SHOP SUPERMARKET COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHARMACY SYSTEMS
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-770-8782
Mailing Address - Street 1:999 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2130
Mailing Address - Country:US
Mailing Address - Phone:631-281-3610
Mailing Address - Fax:631-281-8924
Practice Address - Street 1:999 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2130
Practice Address - Country:US
Practice Address - Phone:631-281-3610
Practice Address - Fax:631-281-8924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3357084OtherNCPDP
NY02949237Medicaid
NY0575340320Medicare NSC