Organization
SHAWS SUPERMARKETS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ENROLLMENT ASSISTANT MANAGER)
(208) 395-3906
Entity
Organization
Contact information
Practice address
1 ORCHARD VIEW DR, LONDONDERRY, NH 03053
(603) 437-6933
(603) 437-4531
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
0654P
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110000004S
—
MA
01
—
2053778
PK
—
05
—
3074453
—
NH
Enumeration date
05/26/2006
Last updated
06/27/2018
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