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Provider Information for 1154430692


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THRIFTY PAYLESS INC

Other Names:  
Doing Business As: 
RITE AID PHARMACY 05401

Organization Subpart: NO

NPI: 1154430692
Last Updated: 2009-03-17
Certification Date:

Details

NameValue
NPI1154430692
Enumeration Date2006-08-29
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: JENNIFER ZOREK
Title: MANAGER ONLINE ADJUDICATION
Phone: 7179755937
Mailing Address 200 NEWBERRY COMMONS
ETTERS, PA 17319-9363
United States

Phone: 717-761-2633 | Fax:717-975-8659
 
Primary Practice Address 1000 POCATELLO CREEK ROAD
FOOTHILL PLAZA
POCATELLO, ID 83201-2999
United States

Phone: 208-234-0757 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)1303433Other ID Number-Commercial Number
MEDICAIDID804029400
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyIDID1202CP