Organization
STOP AND SHOP SUPERMARKET CO LLC
Active
Other names
STOP AND SHOP PHARMACY #642
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
747 PINE ST, BRISTOL, CT 06010-6925
(860) 583-9213
(860) 584-2755
Mailing address
747 PINE ST, BRISTOL, CT 06010-6925
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1676
CT
333600000X
Pharmacy
1676
CT
3336C0003X
Community/Retail Pharmacy
Primary
1676
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0717706
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
940004189248
—
CT
Enumeration date
07/11/2006
Last updated
10/21/2011
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