Provider Demographics
NPI:1710087150
Name:MAXI DRUG NORTH INC
Entity Type:Organization
Organization Name:MAXI DRUG NORTH INC
Other - Org Name:RITE AID PHARMACY 10268
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER ONLINE ADJUDICATION
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
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 COMMONS
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:717-761-2633
Mailing Address - Fax:717-975-8659
Practice Address - Street 1:586 NASHUA ST
Practice Address - Street 2:UNIT 8-9
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4992
Practice Address - Country:US
Practice Address - Phone:603-672-7602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NH0618P3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30701954Medicaid
3006687OtherOTHER ID NUMBER
NH001250801Medicare PIN
3006687OtherOTHER ID NUMBER
NHP00949717Medicare PIN