The Stop & Shop Supermarket Company, LLC
Organization Active NPI Community/Retail Pharmacy · Vernon Rockville, CT
NPI 1194048165 · NPPES record last updated Sep 23, 2024
Key facts
- NPI
- 1194048165
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PCY0001551 (CT)
- Legal business name
- THE STOP & SHOP SUPERMARKET COMPANY, LLC
- Practice address
- 50 Windsorville Rd
Vernon Rockville, CT 06066-2385 - Phone
- (860) 870-6255
- NPI assigned
- Mar 5, 2010
- Organization subpart
- No
Authorized official
- Name
- Gordon Reid
- Title
- President
- Phone
- (301) 341-3906
Corporate family (same tax ID) 24
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Stop & Shop Pharmacy #2614 |
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 |
| O20100930080706 | CT | DME Supplier - Pharmacy | 5698841864 | Practice locations: Vernon, 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 | |||
| Community/Retail Pharmacy | 3336C0003X | PCY0001551 | CT | Yes |
Addresses
Primary practice location
50 Windsorville Rd
Vernon Rockville, CT 06066-2385
Mailing address
1149 Harrisburg Pike
Carlisle, PA 17013-1607
Phone (717) 240-5520
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008014125 | Medicaid | CT |
Other providers in Vernon Rockville, CT
- Chandra Singh-Wilson
- Robert Soderberg
- Sound Advice Audiology LLC
- Karen Stickney
- Jessica Sullivan
- Vincent'S Pharmacy, Inc.
- Anna E Viscuso
- Walgreen Co
- Fang Wang
- Janine M. a.. Wilcox
All providers in Vernon Rockville, 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.