1760403653 NPI number — THRIFTY PAYLESS INC

Table of content: (NPI 1760403653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760403653 NPI number — THRIFTY PAYLESS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THRIFTY PAYLESS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RITE AID PHARMACY 05287
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760403653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 NEWBERRY COMMONS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ETTERS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17319-9363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-761-2633
Provider Business Mailing Address Fax Number:
717-975-8659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 KELSO DRIVE
Provider Second Line Business Practice Location Address:
RIVERWAY PLAZA
Provider Business Practice Location Address City Name:
KELSO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98626-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-577-2693
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZOREK
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER ONLINE ADJUDICATION
Authorized Official Telephone Number:
717-975-5937

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  262010404292 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 262010404292 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 165036 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6017040 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6017040 . This is a "MEDICAID DME" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 4922236 . This is a "NCPDP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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