Provider Demographics
NPI:1104216571
Name:THRIFTY PAYLESS INC
Entity Type:Organization
Organization Name:THRIFTY PAYLESS INC
Other - Org Name:RITE AID PHARMACY 06711
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR MANAGER PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNFIER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-975-5937
Mailing Address - Street 1:200 NEWBERRY CMNS
Mailing Address - Street 2:
Mailing Address - City:ETTERS
Mailing Address - State:PA
Mailing Address - Zip Code:17319-9363
Mailing Address - Country:US
Mailing Address - Phone:717-975-5937
Mailing Address - Fax:717-975-8659
Practice Address - Street 1:13460 HIGHLANDS PLACE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130
Practice Address - Country:US
Practice Address - Phone:717-761-2633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NABPOther5653907
CA1104216571Medicaid
0791491130Medicare NSC
CAP00949659Medicare PIN
NABPOther5653907