Organization
SHAWS SUPERMARKETS INC
Active
Other names
Shaws Pharmacy #1414
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ENROLLMENT ASSISTANT MANAGER)
(208) 395-3906
Entity
Organization
Contact information
Practice address
230 MAIN ST, MEDFIELD, MA 02052
(508) 359-6855
(508) 359-7519
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
(208) 395-6200
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
DS3317
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110000003T
—
MA
01
—
2039351
PK
—
Enumeration date
05/26/2006
Last updated
07/03/2024
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