NPIMap

Organization Active NPI

Stop and Shop Supermarket Co LLC

  • Community/Retail Pharmacy
  • Lake Ronkonkoma, NY
National Provider Identifier
1114959079
Registry record updated Oct 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
026854 Issued in NY
Legal business name
STOP AND SHOP SUPERMARKET CO LLC
Practice address
425 Portion Rd
Lake Ronkonkoma, NY 11779-4579
Phone
(631) 737-1736
Fax
(631) 737-2879
NPI assigned
Jul 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2011

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

Authorized official

Name
Brad Dayton
Title
Director
Phone
(617) 770-8782

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 026854 NY
Pharmacy 333600000X 026854 NY
Community/Retail Pharmacy 3336C0003X 026854 NY Primary

Addresses

Primary practice location

425 Portion Rd
Lake Ronkonkoma, NY 11779-4579

Mailing address

425 Portion Rd
Lake Ronkonkoma, NY 11779-4579

Other identifiers 2

IdentifierTypeStateIssuer
3339618OtherOTHER ID NUMBER-COMMERCIAL NUMBER
02586478MedicaidNY

Other names 1

  • STOP AND SHOP PHARMACY #544 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NY2 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
O20100930085023 NY DME Supplier - PharmacyDME Supplier - Grocery Store 5698841864 Practice locations: Lake Ronkonkoma, NY

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Stop & Shop Pharmacy #544425 Portion Rd, Lake Ronkonkoma, NY 11779-4579(631) 737-1736 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 assignmentParticipating since Sep 1, 2009

National Provider Directory

National Provider Directory
Tax ID family
Stop Shop Pharmacy 434214 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

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

View all 18

Locations

425 Portion Rd
Lake Ronkonkoma, NY 11779
Phone (631) 737-1736

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318982400000",
    "number": "1114959079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 PORTION RD",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117794579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 PORTION RD",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117794579",
            "telephone_number": "631-737-1736",
            "fax_number": "631-737-2879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOP AND SHOP SUPERMARKET CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2011-10-19",
        "status": "A",
        "authorized_official_last_name": "DAYTON",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "617-770-8782"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "026854",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "026854",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "026854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3339618",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02586478",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STOP AND SHOP PHARMACY #544",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Ronkonkoma, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.