Organization
STOP AND SHOP SUPERMARKET CO LLC
Active
Other names
STOP AND SHOP PHARMACY #694
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
79 WASHINGTON AVE, NORTH HAVEN, CT 06473-1704
(203) 234-7461
(203) 234-7468
Mailing address
79 WASHINGTON AVE, NORTH HAVEN, CT 06473-1704
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1745
CT
333600000X
Pharmacy
1745
CT
3336C0003X
Community/Retail Pharmacy
Primary
1745
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0718506
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
940004201505
—
CT
Enumeration date
07/07/2006
Last updated
10/26/2011
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