Organization
MAXI DRUG SOUTH LP
Active
Other names
RITE AID PHARMACY 10250
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
1764 BROAD STREET, CRANSTON, RI 02905-3519
(401) 461-6438
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
PHA00291
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4105082
OTHER ID NUMBER
—
05
—
MD11340
—
RI
Enumeration date
09/22/2006
Last updated
03/24/2009
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