1326271800 NPI number — STOP & SHOP SUPERMARKET COMPANY LLC

Table of content: (NPI 1326271800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326271800 NPI number — STOP & SHOP SUPERMARKET COMPANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STOP & SHOP SUPERMARKET COMPANY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STOP & SHOP PHARMACY #2701
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326271800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1385 HANCOCK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02169-5103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-770-8732
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1925 PAWTUCKET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
E PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02914-1642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-726-5332
Provider Business Practice Location Address Fax Number:
401-728-1640
Provider Enumeration Date:
08/31/2009

Additional Information

Authorized Official

Authorized Official Last Name:
STONE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR THIRD PARTY
Authorized Official Telephone Number:
617-770-6257

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4107264 . This is a "NCPDP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: SS77528 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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