NPIMap

Organization Active NPI

Stop and Shop Supermarket Co LLC

Doing business as Stop and Shop Pharmacy #615

  • Community/Retail Pharmacy
  • Norwich, CT
National Provider Identifier
1225060197
Registry record updated Jun 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
00937 Issued in CT
Legal business name
STOP AND SHOP SUPERMARKET CO LLC
Doing business as
Stop and Shop Pharmacy #615
Practice address
42 Town St
Norwich, CT 06360-2316
Phone
(860) 887-1615
Fax
(860) 886-6207
NPI assigned
Jul 7, 2006
Last updated
Jun 25, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2009

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

Authorized official

Name
Bob Stone
Title
Dir 3Rd Party Managed Care
Phone
(617) 770-6257

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 00937 CT
Pharmacy 333600000X 00937 CT
Community/Retail Pharmacy 3336C0003X 00937 CT Primary

Addresses

Primary practice location

42 Town St
Norwich, CT 06360-2316

Mailing address

42 Town St
Norwich, CT 06360-2316

Other identifiers 2

IdentifierTypeStateIssuer
940004126109MedicaidCT
0714774OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • STOP AND SHOP PHARMACY #615 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CT2 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
O20100930032005 CT DME Supplier - PharmacyDME Supplier - Grocery Store 5698841864 Practice locations: Norwich, CT

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D2016840Stop & Shop Pharmacy #61542 Town St, Norwich, CT 06360Certificate of waiverNov 28, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Stop and Shop Supermarket Co LLC42 Town St, Norwich, CT 06360-2316(860) 887-1615 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 and Shop Pharmacy214 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

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": "1245888000000",
    "number": "1225060197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 TOWN ST",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 TOWN ST",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602316",
            "telephone_number": "860-887-1615",
            "fax_number": "860-886-6207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOP AND SHOP SUPERMARKET CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2009-06-25",
        "status": "A",
        "authorized_official_last_name": "STONE",
        "authorized_official_first_name": "BOB",
        "authorized_official_title_or_position": "DIR 3RD PARTY MANAGED CARE",
        "authorized_official_telephone_number": "617-770-6257"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CT",
            "license": "00937",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CT",
            "license": "00937",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CT",
            "license": "00937",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "940004126109",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0714774",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STOP AND SHOP PHARMACY #615",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Norwich, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2009; 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.