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Organization
MAXI DRUG SOUTH LP
Active
Organization
MAXI DRUG SOUTH LP
Active
Other names
RITE AID PHARMACY 10243
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
170 GRANITE STREET, WESTERLY, RI 02891-2462
(401) 596-2734
Mailing address
200 NEWBERRY COMMONS, ETTERS, PA 17319-9363
(717) 761-2633
(717) 975-8659
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHA00290
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008001859
—
CT
01
—
1910098
MEDICAID DME
RI
01
—
4105284
NCPDP
—
05
—
MD11339
—
RI
Enumeration date
09/22/2006
Last updated
12/13/2011
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