Organization
STOP & SHOP SUPERMARKET COMPANY, LLC
Active
Parent organization
AHOLDUSA
Other names
STOP & SHOP PHARMACY 2595
Organization subpart
Yes
Provider details
NPI number
Legal business name
AHOLDUSA
Authorized official
ROGER WHEELER (PRESIDENT OF PHARMACY)
(207) 883-2911
Entity
Organization
Contact information
Practice address
1351 FOREST AVE, STATEN ISLAND, NY 10302-2049
(718) 448-6758
(718) 981-0540
Mailing address
1149 HARRISBURG PIKE, ATTN: THIRD PARTY COORDINATOR, CARLISLE, PA 17013-1607
(717) 960-8553
(717) 960-1389
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
034058
STATE LICENSE
NY
Enumeration date
09/30/2015
Last updated
05/28/2025
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