Organization
MAXI DRUG INC
Active
Other names
RITE AID PHARMACY 10361
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER M ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
922 SOUTH MAIN STREET, CHESHIRE, CT 06410-3419
(203) 271-0282
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
1147
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004136827
—
CT
01
—
004244852
MEDICAID DME
CT
01
—
0715651
NCPDP
—
Enumeration date
09/22/2006
Last updated
02/13/2012
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