NPIMap

Organization Active NPI

Stop & Shop Supermarket Company, LLC

  • Community/Retail Pharmacy
  • Staten Island, NY
National Provider Identifier
1457721680
Registry record updated May 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
STOP & SHOP SUPERMARKET COMPANY, LLC
Practice address
1351 Forest Ave
Staten Island, NY 10302-2049
Phone
(718) 448-6758
Fax
(718) 981-0540
NPI assigned
Sep 30, 2015
Organization subpart
Yes
Parent organization
AHOLDUSAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 28, 2025

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

Authorized official

Name
Roger Wheeler
Title
President of Pharmacy
Phone
(207) 883-2911

Specialties & licenses 2

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

Addresses

Primary practice location

1351 Forest Ave
Staten Island, NY 10302-2049

Mailing address

1149 Harrisburg Pike
Attn: Third Party Coordinator
Carlisle, PA 17013-1607
Phone (717) 960-8553

Other identifiers 1

IdentifierTypeStateIssuer
034058OtherNYSTATE LICENSE

Other names 1

  • STOP & SHOP PHARMACY 2595 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NY2 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
O20160416000012 NY DME Supplier - Pharmacy 5698841864 Practice locations: Staten Island, NY

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Stop & Shop Pharmacy 25951351 Forest Ave, Staten Island, NY 10302-2049(718) 448-6758 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 Shop Pharmacy 434214 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": "1443571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748390400000",
    "number": "1457721680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 HARRISBURG PIKE",
            "address_2": "ATTN: THIRD PARTY COORDINATOR",
            "city": "CARLISLE",
            "state": "PA",
            "postal_code": "170131607",
            "telephone_number": "717-960-8553",
            "fax_number": "717-960-1389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103022049",
            "telephone_number": "718-448-6758",
            "fax_number": "718-981-0540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOP & SHOP SUPERMARKET COMPANY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AHOLDUSA",
        "enumeration_date": "2015-09-30",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "PRESIDENT OF PHARMACY",
        "authorized_official_telephone_number": "207-883-2911"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "034058",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STOP & SHOP PHARMACY 2595",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; 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.