Stop and Shop Supermarket Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

026960 Issued in NY

Legal business name

STOP AND SHOP SUPERMARKET CO LLC

Doing business as

STOP AND SHOP PHARMACY #579

Practice address

294 Middle Country Rd
Coram, NY 11727-4428

Phone

(631) 736-5168

Fax

(631) 736-5733

NPI assigned

Jul 7, 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 #579 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 3

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

• Gary M Jordan, RPH

  • Pharmacist
  • Coram, NY
  • NPI 1477731255
  NPD (past)
• Teena Koshy, RPH

  • Pharmacist
  • Farmingville, NY
  • NPI 1881916070
  NPD (past)
• Nilpuar Rahman, RPH

  • Pharmacist
  • Coram, NY
  • NPI 1588996482
  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": "1318982400000",
    "number": "1932131893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "294 MIDDLE COUNTRY RD",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117274428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "294 MIDDLE COUNTRY RD",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117274428",
            "telephone_number": "631-736-5168",
            "fax_number": "631-736-5733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOP AND SHOP SUPERMARKET CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2011-10-19",
        "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": "NY",
            "license": "026960",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "026960",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "026960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3339707",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02598790",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STOP AND SHOP PHARMACY #579",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel E Stern, D.P.M.
• Lauren Stewart, LMHC
• Janet Audrey Stone, NP, CNM
• Summer Theresa Stone, LPN
• Stony Brook University Medical Center
• Jennifer Stosch
• Bari Stricoff, RD
• Cynthia Stusvick
• Leah Sue-Ho, LPN
• Suffolk Dental Care, PC

• Community/Retail Pharmacy in Coram, NY
• Providers in Coram, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 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.