Provider Demographics
NPI:1790191021
Name:THRIFTY DRUG STORES INC.
Entity Type:Organization
Organization Name:THRIFTY DRUG STORES INC.
Other - Org Name:THRIFTY WHITE PHARMACY #783
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP PHARMACY
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:763-513-4388
Mailing Address - Fax:763-248-7581
Practice Address - Street 1:36 S BROADWAY
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:MN
Practice Address - Zip Code:56097-1633
Practice Address - Country:US
Practice Address - Phone:507-553-3161
Practice Address - Fax:507-553-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
MN2644963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1790191021Medicaid
2146915OtherPK
MN1790191021Medicaid
0311770075Medicare NSC