Organization
THRIFTY PAYLESS INC
Active
Other names
Rite Aid Pharmacy 05593
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
13905 AMAR ROAD, LA PUENTE, CA 91746-1670
(626) 338-9717
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
PHY42260
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY42260
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0515645
NCPDP
CA
05
—
BBBPHA422600
—
CA
01
—
PHA422600
MEDICAID DME
CA
Enumeration date
07/24/2006
Last updated
10/27/2011
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