Stop And Shop Pharmacy #624

LBN: Stop And Shop Supermarket Co Llc
Stop And Shop Pharmacy #624 is an health care organization with primary practice located at 136 Samson Rock Dr , Madison CT 06443-3018. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Stop And Shop Supermarket Co Llc can be contacted via phone (203) 245-7467, or through Dayton, Brad via phone (617) 770-8782.

Contact Information

Primary practice address
136 Samson Rock Dr Madison CT 06443-3018
Phone: (203) 245-7467
Fax: (203) 245-7014
Website:
Map and Directions
Authorized official contact:
Name: Dayton, Brad
Phone: (617) 770-8782

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X 1748 Connecticut
Suppliers / Pharmacy 333600000X 1748 Connecticut
Suppliers / Community/Retail Pharmacy 3336C0003X 1748 Connecticut

Profile Details

NPI number 1104858075
LBN Legal business name Stop And Shop Supermarket Co Llc
DBA Doing business as Stop And Shop Pharmacy #624
Authorized official Dayton, Brad
Entity Organization
Organization subpart 1 No
Enumeration date Jul 7th, 2006
Last updated Oct 21st, 2011 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104858075 NPPES
Connecticut MEDICAID 940004203387
Connecticut MEDICAID 004203387
Connecticut Other 0718544

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