Organization
MAXI DRUG SOUTH LP
Active
Other names
RITE AID PHARMACY 06595
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER M ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
1011 CRANSTON STREET, CRANSTON, RI 02920-7533
(401) 275-0849
Mailing address
200 NEWBERRY COMMONS, ETTERS, PA 17319
(717) 761-2633
(717) 975-8659
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4107187
NCPDP
RI
01
—
4529220
MEDICAID DME
RI
05
—
MD76002
—
RI
Enumeration date
04/10/2009
Last updated
12/13/2011
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