The Stop & Shop Supermarket Company, LLC
Organization Active NPI Community/Retail Pharmacy · Madison, CT
NPI 1104858075 · NPPES record last updated Sep 23, 2024
Key facts
- NPI
- 1104858075
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 1748 (CT)
- Legal business name
- THE STOP & SHOP SUPERMARKET COMPANY, LLC
- Practice address
- 136 Samson Rock Dr
Madison, CT 06443-3018 - Phone
- (203) 245-7467
- Fax
- (203) 245-7014
- NPI assigned
- Jul 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Gordon Reid
- Title
- President
- Phone
- (301) 341-3906
Corporate family (same tax ID) 22
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D2111006 | Stop & Shop #624 | Certificate of waiver | Mar 28, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Stop & Shop Pharmacy #624 |
Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Ostomy Supplies|Urological Supplies|Surgical Dressings | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080912000121 | TX | Part B Supplier - Centralized Flu Biller | 5698841864 | This NPI is an additional NPI on the enrollment |
| O20100930090127 | CT | DME Supplier - Pharmacy |
5698841864 | Practice locations: Madison, CT |
National Provider Directory
- Tax ID family
- Stop Shop Pharmacy 434
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 1748 | CT | |
| Pharmacy | 333600000X | 1748 | CT | |
| Community/Retail Pharmacy | 3336C0003X | 1748 | CT | Yes |
Addresses
Primary practice location
136 Samson Rock Dr
Madison, CT 06443-3018
Mailing address
136 Samson Rock Dr
Madison, CT 06443-3018
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0718544 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 940004203387 | Medicaid | CT | |
| 004203387 | Medicaid | CT |
Other names
- STOP AND SHOP PHARMACY #624
Other providers in Madison, CT
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- Sharon C Telford
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- The Harp Group, LLC
- The Marlan Group,LLC.
- The Wellness Place
- Tara Ticomb
- Scott A Tordoff
- Touchpoint Physical Therapy, LLC
- Town of Madison
All providers in Madison, CT · Community/Retail Pharmacy in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.