Organization
MAXI GREEN INC
Active
Other names
RITE AID PHARMACY 10309
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
12 NORTH MAIN STREET, RANDOLPH, VT 05060-1127
(802) 728-3722
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
380003284
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1006099
—
VT
01
—
4703434
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/31/2006
Last updated
04/11/2012
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