# MAXI DRUG SOUTH LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** RITE AID PHARMACY 10249
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386744712
- **Authorized official:** JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
- **Authorized official phone:** (717) 975-5937

## Contact information

- **Practice address:** 456 BRANCH AVENUE, PROVIDENCE, RI 02904-2205
- **Practice address phone:** (401) 331-3554
- **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 | PHA00330 | RI | Yes |

## Other

- **Enumeration date:** 09/25/2006
- **Last updated:** 12/13/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4105981 | OTHER ID NUMBER | — |
| 05 | — | MD29637 | — | RI |