Organization
MAXI DRUG INC
Active
Other names
RITE AID PHARMACY 10390
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER M ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
82 HOYT STREET, STAMFORD, CT 06905-5701
(203) 325-8190
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
1475
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004136801
—
CT
01
—
004244688
MEDICAID DME
CT
01
—
0715942
NCPDP
—
Enumeration date
09/22/2006
Last updated
09/17/2020
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