1003139163 NPI number — THE STOP & SHOP SUPERMARKET COMPANY LLC

Table of content: (NPI 1003139163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003139163 NPI number — THE STOP & SHOP SUPERMARKET COMPANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE 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 #2613
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:
1003139163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1149 HARRISBURG PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLISLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17013-1607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-240-5520
Provider Business Mailing Address Fax Number:
717-960-8371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 KITTS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06111-4250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-594-7123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FARRELL
Authorized Official First Name:
ALISON
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
717-240-1526

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PCY0001586 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008014127 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0721806 . This is a "NCPDP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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