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Organization
MAXI GREEN INC
Active
Organization
MAXI GREEN INC
Active
Other names
RITE AID PHARMACY 10312
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
213 MAIN STREET, LUDLOW SHOPPING PLAZA, LUDLOW, VT 05149
(802) 228-8477
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
380003325
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007887
—
VT
01
—
4703838
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/31/2006
Last updated
04/11/2012
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