Organization
MAXI DRUG NORTH INC
Active
Other names
RITE AID PHARMACY 10290
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
1390 LAFAYETTE ROAD, PORTSMOUTH, NH 03801-5649
(603) 430-7595
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
0721-P
NH
3336C0003X
Community/Retail Pharmacy
Primary
0721-P
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
157130007
ME MEDICAID
NH
05
—
157130007
—
ME
01
—
3006714
OTHER ID NUMBER
—
05
—
30701957
—
NH
Enumeration date
09/22/2006
Last updated
08/28/2013
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