Organization
THE STOP & SHOP SUPERMARKET COMPANY, LLC
Active
Other names
STOP AND SHOP PHARMACY #688
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON REID (PRESIDENT)
(301) 341-3906
Entity
Organization
Contact information
Practice address
105 ELM ST, OLD SAYBROOK, CT 06475-4132
(860) 388-6461
(860) 388-5145
Mailing address
105 ELM ST, OLD SAYBROOK, CT 06475-4132
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1357
CT
333600000X
Pharmacy
1357
CT
3336C0003X
Community/Retail Pharmacy
Primary
1357
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0713138
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
940004089894
—
CT
Enumeration date
07/19/2006
Last updated
09/23/2024
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