Organization
THRIFTY PAYLESS INC
Active
Other names
RITE AID PHARMACY 05421
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
1810 WEST PULLMAN ROAD, PALOUSE EMPIRE MALL, MOSCOW, ID 83843-4014
(208) 882-3583
Mailing address
200 NEWBERRY COMMONS, ETTERS, PA 17319-9363
(717) 761-2633
(717) 975-8659
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
ID1220CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1305451
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
6011530
MEDICAID DME
WA
05
—
6011530
—
WA
05
—
804029200
—
ID
Enumeration date
08/29/2006
Last updated
04/04/2023
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