The Stop & Shop Supermarket Company LLC
Organization Active NPI Community/Retail Pharmacy · Colchester, CT
NPI 1124050091 · NPPES record last updated Sep 9, 2025
Key facts
- NPI
- 1124050091
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 1599 (CT)
- Legal business name
- THE STOP & SHOP SUPERMARKET COMPANY LLC
- Practice address
- 99 Linwood Ave
Colchester, CT 06415-1100 - Phone
- (860) 537-2570
- Fax
- (860) 537-2598
- NPI assigned
- Jul 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Roger Wheeler
- Title
- President
- Phone
- (617) 689-4130
Corporate family (same tax ID) 23
Practitioners 3
-
Kimberly Smith, PHARM.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D2016836 | Stop & Shop Pharmacy #608 | Certificate of waiver | Nov 28, 2026 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Stop & Shop Pharmacy #608 |
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 |
| O20100930065006 | CT | DME Supplier - Pharmacy |
5698841864 | Practice locations: Colchester, CT |
National Provider Directory
- Tax ID family
- Stop Shop Pharmacy 434
Locations
99 Linwood Ave
Colchester, CT 06415
Phone (860) 537-2570
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 1599 | CT | |
| Pharmacy | 333600000X | 1599 | CT | |
| Community/Retail Pharmacy | 3336C0003X | 1599 | CT | Yes |
Addresses
Primary practice location
99 Linwood Ave
Colchester, CT 06415-1100
Mailing address
99 Linwood Ave
Colchester, CT 06415-1159
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0716881 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 940004162666 | Medicaid | CT |
Other names
- STOP AND SHOP PHARMACY #608
Other providers in Colchester, CT
- Kristie L Tapper
- Tara Hast LMFT LLC
- Melinda Tarbell
- Bella Tenenbaum
- The Nurse'S Office Primary Care and Walk-in Center, LLC
- Gail June Tittle
- Anthony Todt
- Town of Colchester
- Tranquil Medical Supplies
- Jeremy Tulledge Mitchell
All providers in Colchester, 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 9, 2025. 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.