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
—
—
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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