Organization
THRIFTY PAYLESS INC
Active
Other names
RITE AID PHARMACY 05754
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
13151 JAMBOREE ROAD, TUSTIN, CA 92782-9150
(714) 573-0908
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
PHY42849
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0510619
OTHER ID NUMBER COMMERCIAL NUMBER
—
05
—
PHA428490
—
CA
Enumeration date
08/30/2006
Last updated
10/31/2011
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