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Martins Foods of South Burlington LLC

Organization Active NPI Community/Retail Pharmacy · Utica, NY

NPI 1114035599 · NPPES record last updated Sep 19, 2025

Key facts

NPI
1114035599
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
027691 (NY)
Legal business name
MARTINS FOODS OF SOUTH BURLINGTON LLC
Practice address
1122 Mohawk St
Utica, NY 13501-3751
Phone
(315) 235-0204
Fax
(315) 235-0214
NPI assigned
Aug 27, 2006
Organization subpart
No

Authorized official

Name
Michael Vail
Title
President and Manager
Phone
(207) 885-7454

Other NPIs on the same Medicare enrollment 45

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 45

Corporate family (same tax ID) 17

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Hannaford Supermarket Pharmacy 8372
1122 Mohawk St, Utica, NY 13501-3750 · (315) 235-0204		 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
Participating since Jan 1, 2001

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in NY

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930030831 NY DME Supplier - Pharmacy
DME Supplier - Grocery Store		 7517085293 Practice locations: Utica, NY
O20111031000005 NY Part B Supplier - Mass Immunization (Roster Biller Only) 7517085293 45 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New Hartford, NY; New Windsor, NY; Niskayuna, NY; Oneonta, NY; Pawling, NY; Pine Bush, NY; Plattsburgh, NY; Queensbury, NY…

National Provider Directory

Tax ID family
Shop N Save Pharmacy (60 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 027691 NY Yes

Addresses

Primary practice location

1122 Mohawk St
Utica, NY 13501-3751

Mailing address

PO Box 1000
Ms 3000
Portland, ME 04104-5005
Phone (207) 885-7454

Other identifiers

IdentifierTypeStateIssuer
2067535OtherPK
02744003MedicaidNY

Other names

  • HANNAFORD FOOD AND DRUG Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 19, 2025.

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1114035599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "address_2": "MS 3000",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041045005",
            "telephone_number": "207-885-7454",
            "fax_number": "704-645-6531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 MOHAWK ST",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135013751",
            "telephone_number": "315-235-0204",
            "fax_number": "315-235-0214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTINS FOODS OF SOUTH BURLINGTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-27",
        "last_updated": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "VAIL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT AND MANAGER",
        "authorized_official_telephone_number": "207-885-7454"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "027691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2067535",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02744003",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HANNAFORD FOOD AND DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Utica, NY

All providers in Utica, NY · Community/Retail Pharmacy in New York

Sources for this page

Verify at the official NPI Registry.