Provider Demographics
NPI:1689727026
Name:THRIFTEE FOOD AND DRUG
Entity Type:Organization
Organization Name:THRIFTEE FOOD AND DRUG
Other - Org Name:THRIFTEE FOOD AND DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:BS RPH
Authorized Official - Phone:928-424-2374
Mailing Address - Street 1:755 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-2722
Mailing Address - Country:US
Mailing Address - Phone:928-428-1156
Mailing Address - Fax:928-428-2891
Practice Address - Street 1:755 S CENTRAL AVE
Practice Address - Street 2:755 S CENTRAL AVENUE
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2722
Practice Address - Country:US
Practice Address - Phone:928-428-1156
Practice Address - Fax:928-428-2891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZY0019923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ039877Medicaid
1988369OtherPK