Organization
STOP & SHOP SUPERMARKET COMPANY, LLC
Active
Other names
STOP AND SHOP PHARMACY #55
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON REID (PRESIDENT)
(301) 341-3906
Entity
Organization
Contact information
Practice address
932 N MONTELLO ST, BROCKTON, MA 02301-1671
(508) 427-6582
(508) 427-6977
Mailing address
932 N MONTELLO ST, BROCKTON, MA 02301-1671
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
3290
MA
333600000X
Pharmacy
3290
MA
3336C0003X
Community/Retail Pharmacy
Primary
3290
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0405922
—
MA
01
—
2240327
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/11/2006
Last updated
07/29/2024
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