# SHAWS SUPERMARKETS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shaws Pharmacy \#1409
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093761520
- **Authorized official:** KATHY GIANNAKOPOULOS (MANAGER, ENROLLMENTS)
- **Authorized official phone:** (208) 395-3954

## Contact information

- **Practice address:** 476 LIBERTY ST, HANSON, MA 02341
- **Practice address phone:** (781) 293-0561
- **Practice address fax:** (781) 293-0529
- **Mailing address:** 250 E PARKCENTER BLVD, BOISE, ID 83706-3940

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | DS2854 | MA | Yes |

## Other

- **Enumeration date:** 05/26/2006
- **Last updated:** 07/01/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 110000004J | — | MA |
| 01 | — | 2038633 | PK | — |