1316036924 NPI number — THRIFTY DRUG STORES INC

Table of content: (NPI 1316036924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316036924 NPI number — THRIFTY DRUG STORES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THRIFTY DRUG STORES 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:
Provider Other Organization Name Type Code:
6
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:
1316036924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6701 EVENSTAD DR N STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLE GROVE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55369-6013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-513-4300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 E HIGHWAY 28
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56267-1186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-589-4550
Provider Business Practice Location Address Fax Number:
320-589-4555
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEIPPERT
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
763-585-3507

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 262006 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000021420TH , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2048212 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 053443900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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