Organization
STOP AND SHOP SUPERMARKET CO LLC
Active
Other names
STOP AND SHOP PHARMACY #613
Organization subpart
No
Provider details
NPI number
Authorized official
BOB STONE (DIR 3RD PARTY MANAGED CARE)
(617) 770-6257
Entity
Organization
Contact information
Practice address
10 PITKIN RD, VERNON, CT 06066-4709
(860) 871-1053
(860) 871-1325
Mailing address
10 PITKIN RD, VERNON, CT 06066-4709
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
01645
CT
333600000X
Pharmacy
01645
CT
3336C0003X
Community/Retail Pharmacy
Primary
01645
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0717338
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
940004178522
—
CT
Enumeration date
07/07/2006
Last updated
06/25/2009
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