NPIMap

Organization Active NPI

Shaws Supermarkets Inc

  • Community/Retail Pharmacy
  • New Haven, CT
National Provider Identifier
1093761488
Registry record updated Jan 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PCY0001667 Issued in CT
Legal business name
SHAWS SUPERMARKETS INC
Practice address
150 Whalley Ave
New Haven, CT 06511-3250
Phone
(203) 495-9630
Fax
(203) 495-9676
NPI assigned
May 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2018

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

Authorized official

Name
Demond Hawkins
Title
Third Party Manager
Phone
(208) 395-3905

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PCY0001667 CT Primary

Addresses

Primary practice location

150 Whalley Ave
New Haven, CT 06511-3250

Mailing address

3030 Cullerton St
Franklin Park, IL 60131-2205

Other identifiers 2

IdentifierTypeStateIssuer
0717655OtherNCPDP PROVIDER IDENTIFICATION NUMBER
004187367MedicaidCT

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

150 Whalley Ave
New Haven, CT 06511
Phone (203) 495-9630

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516579200000",
    "number": "1093761488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 CULLERTON ST",
            "city": "FRANKLIN PARK",
            "state": "IL",
            "postal_code": "601312205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 WHALLEY AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065113250",
            "telephone_number": "203-495-9630",
            "fax_number": "203-495-9676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWS SUPERMARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2018-01-22",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "DEMOND",
        "authorized_official_title_or_position": "THIRD PARTY MANAGER",
        "authorized_official_telephone_number": "208-395-3905"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CT",
            "license": "PCY0001667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0717655",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004187367",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.