Organization
SHAWS SUPERMARKETS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEMOND HAWKINS (THIRD PARTY MANAGER)
(208) 395-3905
Entity
Organization
Contact information
Practice address
425 BROAD ST, MANCHESTER, CT 06040-4035
(860) 643-3477
(860) 643-3472
Mailing address
3030 CULLERTON ST, FRANKLIN PARK, IL 60131-2205
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PCY0001552
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004141321
—
CT
01
—
0716437
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/25/2006
Last updated
01/22/2018
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