Stop and Shop Supermarket Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

1371 Issued in CT

Legal business name

STOP AND SHOP SUPERMARKET CO LLC

Doing business as

Stop and Shop Pharmacy #635

Practice address

100 Division St
Ansonia, CT 06401-2147

Phone

(203) 732-3907

Fax

(203) 732-4329

NPI assigned

Jul 7, 2006

Last updated

Oct 21, 2011By the provider in NPPES

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 #635 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel Gray, RPH

  • Pharmacist
  • Ansonia, CT
  • NPI 1487131413
  NPD (past)
• Teresa Revell, PHARMD

  • Pharmacist
  • Ansonia, CT
  • NPI 1952888513
  NPD (past)

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319155200000",
    "number": "1326070285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 DIVISION ST",
            "city": "ANSONIA",
            "state": "CT",
            "postal_code": "064012147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 DIVISION ST",
            "city": "ANSONIA",
            "state": "CT",
            "postal_code": "064012147",
            "telephone_number": "203-732-3907",
            "fax_number": "203-732-4329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOP AND SHOP SUPERMARKET CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "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": "1371",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CT",
            "license": "1371",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CT",
            "license": "1371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "940004093077",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0713316",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STOP AND SHOP PHARMACY #635",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Ellie Stankus, APRN, RN
• Ira J Stein, DDS
• Stephen Moses, M.D., LLC
• Jennifer L Stevens, LPC
• Patrick Stone, LPC
• Talk It Out Counseling LLC
• CHI Tang, MD
• Sara Targouski
• Andrea Charlene Tavlan, MD
• Cheryl Tedesco

• Community/Retail Pharmacy in Ansonia, CT
• Providers in Ansonia, 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.