Organization
THE STOP & SHOP SUPERMARKET COMPANY, LLC
Active
Other names
STOP AND SHOP PHARMACY #674
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
1391 MAIN ST, WILLIMANTIC, CT 06226-1949
(860) 456-7240
(860) 423-0219
Mailing address
1391 MAIN ST, WILLIMANTIC, CT 06226-1949
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1248
CT
333600000X
Pharmacy
1248
CT
3336C0003X
Community/Retail Pharmacy
Primary
1248
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0712035
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
940004061644
—
CT
Enumeration date
07/07/2006
Last updated
10/31/2024
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