Organization
STOP AND SHOP SUPERMARKET CO LLC
Active
Other names
STOP AND SHOP PHARMACY #614
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
1135 FARMINGTON AVENUE, BERLIN, CT 06037
(860) 828-0772
(860) 828-3521
Mailing address
1135 FARMINGTON AVENUE, BERLIN, CT 06037
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PCY2004
CT
333600000X
Pharmacy
PCY2004
CT
3336C0003X
Community/Retail Pharmacy
Primary
PCY2004
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004254413
—
CT
01
—
0720385
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/07/2006
Last updated
10/21/2011
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