Stop and Shop Supermarket Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

1747 Issued in CT

Legal business name

STOP AND SHOP SUPERMARKET CO LLC

Practice address

855 Bridgeport Ave
Milford, CT 06460-3171

Phone

(203) 876-0654

Fax

(203) 882-9847

NPI assigned

Jul 11, 2006

Organization subpart

No

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

Addresses

Other identifiers 2

Other names 1

• STOP AND SHOP PHARMACY #647 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 4

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

• Daniel Christopher Baxter, PHARM.D.

  • Pharmacist
  • Trumbull, CT
  • NPI 1023363512
  NPD (past)
• Nicole Cammarota

  • Pharmacist
  • Milford, CT
  • NPI 1588334643
  NPD (past)
• Jeannette Lynn Moran

  • Pharmacist
  • Milford, CT
  • NPI 1154816643
  NPD (past)
• Alfred Ragozzine

  • Pharmacist
  • Milford, CT
  • NPI 1831683697
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319155200000",
    "number": "1194750299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 BRIDGEPORT AVE",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064603171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 BRIDGEPORT AVE",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064603171",
            "telephone_number": "203-876-0654",
            "fax_number": "203-882-9847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOP AND SHOP SUPERMARKET CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2011-10-21",
        "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": "CT",
            "license": "1747",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CT",
            "license": "1747",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CT",
            "license": "1747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0718532",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "940004203395",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STOP AND SHOP PHARMACY #647",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Milford, CT
• Providers in Milford, CT by specialty
• Community/Retail Pharmacy in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.