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
11 E HIGH ST, EAST HAMPTON, CT 06424-1022
(860) 267-2771
(860) 267-2055
Mailing address
3030 CULLERTON ST, FRANKLIN PARK, IL 60131-2205
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004263240
—
CT
01
—
0720626
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/11/2006
Last updated
02/02/2018
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