Organization
THRIFTY PAYLESS INC
Active
Other names
RITE AID PHARMACY 05763
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
17904 MAGNOLIA STREET, VILLAGE CENTER, FOUNTAIN VALLEY, CA 92708-5039
(714) 962-9713
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
PHY42339
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY42339
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0516712
NCPDP
CA
05
—
PHA423390
—
CA
Enumeration date
07/24/2006
Last updated
10/31/2011
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