Provider Demographics
NPI:1629510854
Name:THRIFTY DRUG STORES INC
Entity Type:Organization
Organization Name:THRIFTY DRUG STORES INC
Other - Org Name:
Other - Org Type:
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:763-585-3507
Mailing Address - Fax:763-248-7632
Practice Address - Street 1:2018 15TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-0716
Practice Address - Country:US
Practice Address - Phone:507-281-1676
Practice Address - Fax:507-281-2953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN265196333600000X
3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166171OtherPK