NPIMap

Organization Active NPI

The Stop & Shop Supermarket Company, LLC

Doing business as Stop and Shop Pharmacy #675

  • Community/Retail Pharmacy
  • Waterbury, CT
National Provider Identifier
1003841107
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
1781 Issued in CT
Legal business name
THE STOP & SHOP SUPERMARKET COMPANY, LLC
Doing business as
Stop and Shop Pharmacy #675
Practice address
920 Wolcott St
Waterbury, CT 06705-1300
Phone
(203) 755-9538
Fax
(203) 755-9908
NPI assigned
Jul 11, 2006
Last updated
Oct 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gordon Reid
Title
Director
Phone
(207) 885-2518

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1781 CT
Pharmacy 333600000X 1781 CT
Community/Retail Pharmacy 3336C0003X 1781 CT Primary

Addresses

Primary practice location

920 Wolcott St
Waterbury, CT 06705-1300

Mailing address

920 Wolcott St
Waterbury, CT 06705-1300

Other identifiers 2

IdentifierTypeStateIssuer
0718998OtherOTHER ID NUMBER-COMMERCIAL NUMBER
940004215233MedicaidCT

Other names 1

  • STOP AND SHOP PHARMACY #675 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080912000121 TX Part B Supplier - Centralized Flu Biller 5698841864 This NPI is an additional NPI on the enrollment
O20100930071164 CT DME Supplier - PharmacyDME Supplier - Grocery Store 5698841864 Practice locations: Waterbury, CT

National Provider Directory

National Provider Directory
Tax ID family
Stop Shop Pharmacy 022214 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1003841107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 WOLCOTT ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067051300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 WOLCOTT ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067051300",
            "telephone_number": "203-755-9538",
            "fax_number": "203-755-9908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE STOP & SHOP SUPERMARKET COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "REID",
        "authorized_official_first_name": "GORDON",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "207-885-2518"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CT",
            "license": "1781",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CT",
            "license": "1781",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CT",
            "license": "1781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0718998",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "940004215233",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STOP AND SHOP PHARMACY #675",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.