# MAXI GREEN INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** RITE AID PHARMACY 10315
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114933322
- **Authorized official:** JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
- **Authorized official phone:** (717) 975-5937

## Contact information

- **Practice address:** 499 CANAL STREET, UNIT \# 3, BRATTLEBORO, VT 05301
- **Practice address phone:** (802) 257-4204
- **Mailing address:** 200 NEWBERRY COMMONS, ETTERS, PA 17319-9363
- **Mailing address phone:** (717) 761-2633
- **Mailing address fax:** (717) 975-8659

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 380001860 | VT | Yes |

## Other

- **Enumeration date:** 07/31/2006
- **Last updated:** 04/11/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0006664 | — | VT |
| 01 | — | 4701860 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |