Provider Demographics
NPI:1316036916
Name:THRIFTY DRUG STORES INC
Entity Type:Organization
Organization Name:THRIFTY DRUG STORES INC
Other - Org Name:THRIFTY WHITE DRUG #736
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-585-3507
Mailing Address - Street 1:6055 NATHAN LN N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1674
Mailing Address - Country:US
Mailing Address - Phone:763-513-4300
Mailing Address - Fax:763-513-4380
Practice Address - Street 1:201 HORACE AVE N
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2024
Practice Address - Country:US
Practice Address - Phone:218-681-2932
Practice Address - Fax:218-681-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
MN2611513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2046394OtherPK
ND1456138 RXMedicaid
MN465834500Medicaid
ND1456138 RXMedicaid
0311770020Medicare NSC