NPIMap

Organization Active NPI

The Stop & Shop Supermarket Company, LLC

Doing business as Stop and Shop Pharmacy #504

  • Community/Retail Pharmacy
  • Bronx, NY
National Provider Identifier
1508898453
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
24817 Issued in NY
Legal business name
THE STOP & SHOP SUPERMARKET COMPANY, LLC
Doing business as
Stop and Shop Pharmacy #504
Practice address
691 Co Op City Blvd
Bronx, NY 10475-1673
Phone
(718) 862-2883
Fax
(718) 862-3276
NPI assigned
Jul 7, 2006
Last updated
Apr 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 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) 885-2518

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 24817 NY
Pharmacy 333600000X 24817 NY
Community/Retail Pharmacy 3336C0003X 24817 NY Primary

Addresses

Primary practice location

691 Co Op City Blvd
Bronx, NY 10475-1673

Mailing address

1149 Harrisburg Pike
Carlisle, PA 17013-1607
Phone (717) 240-5520

Other identifiers 2

IdentifierTypeStateIssuer
3318296OtherOTHER ID NUMBER-COMMERCIAL NUMBER
02090297MedicaidNY

Other names 1

  • STOP AND SHOP PHARMACY #504 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
O20100930065028 NY DME Supplier - PharmacyDME Supplier - Grocery Store 5698841864 Practice locations: Bronx, 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 #504691 Co Op City Blvd, Bronx, NY 10475-1673(718) 862-2883 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": "1744156800000",
    "number": "1508898453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 HARRISBURG PIKE",
            "city": "CARLISLE",
            "state": "PA",
            "postal_code": "170131607",
            "telephone_number": "717-240-5520",
            "fax_number": "717-960-8371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "691 CO OP CITY BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104751673",
            "telephone_number": "718-862-2883",
            "fax_number": "718-862-3276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE STOP & SHOP SUPERMARKET COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "PRESIDENT OF PHARMACY",
        "authorized_official_telephone_number": "207-885-2518"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "24817",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "24817",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "24817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3318296",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02090297",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STOP AND SHOP PHARMACY #504",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 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.