Provider Demographics
NPI:1932570363
Name:STOP AND SHOP SUPERMARKET CO LLC
Entity Type:Organization
Organization Name:STOP AND SHOP SUPERMARKET CO LLC
Other - Org Name:STOP & SHOP PHARMACY 2818
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP HEALTH & HOUSEHOLD
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-960-5666
Mailing Address - Street 1:1149 HARRISBURG PIKE
Mailing Address - Street 2:ATTN: THIRD PARTY COORDINATOR
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-1607
Mailing Address - Country:US
Mailing Address - Phone:717-960-8553
Mailing Address - Fax:717-960-1389
Practice Address - Street 1:25 KINNELON RD
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2337
Practice Address - Country:US
Practice Address - Phone:973-838-6699
Practice Address - Fax:973-838-1236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHOLDUSA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-12
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0575340337Medicare NSC