Organization
MAXI DRUG SOUTH LP
Active
Other names
Rite Aid Pharmacy 06727
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (SR MA NAGER PROVIDER ENROLLMENT)
(717) 975-5937
Entity
Organization
Contact information
Practice address
500 BROAD STREET, UNIT 6, PROVIDENCE, RI 02927-1234
(401) 868-9070
Mailing address
200 NEWBERRY CMNS, ETTERS, PA 17319-9363
(717) 975-5937
(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
—
4107771
NABP
—
05
—
NM00221
—
RI
Enumeration date
04/22/2015
Last updated
10/09/2015
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