Organization
THE STOP & SHOP SUPERMARKET COMPANY, LLC
Active
Other names
STOP AND SHOP PHARMACY #624
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON REID (PRESIDENT)
(301) 341-3906
Entity
Organization
Contact information
Practice address
136 SAMSON ROCK DR, MADISON, CT 06443-3018
(203) 245-7467
(203) 245-7014
Mailing address
136 SAMSON ROCK DR, MADISON, CT 06443-3018
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1748
CT
333600000X
Pharmacy
1748
CT
3336C0003X
Community/Retail Pharmacy
Primary
1748
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004203387
—
CT
01
—
0718544
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
940004203387
—
CT
Enumeration date
07/07/2006
Last updated
09/23/2024
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