Organization
THRIFTY PAYLESS INC
Active
Other names
RITE AID PHARMACY 06714
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (SR MANAGER PROVIDER ENROLLMENT)
(717) 975-5937
Entity
Organization
Contact information
Practice address
9340 DESCHUTES RD, PALO CEDRO, CA 96073
(800) 748-3243
Mailing address
200 NEWBERRY COMMONS, ETTERS, PA 17319-9363
(717) 975-5937
(717) 975-8659
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY55423
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326447707
MEDICAID DME
CA
05
—
1326447707
—
CA
01
—
5652765
NABP
—
01
—
P00949662
RR PTAN
CA
Enumeration date
08/21/2014
Last updated
05/16/2018
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