Provider Demographics
NPI:1790243046
Name:THRIFTY DRUG STORES INC
Entity Type:Organization
Organization Name:THRIFTY DRUG STORES INC
Other - Org Name:THRIFTY WHITE PHARMACY #793
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR AR & BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-513-4301
Mailing Address - Street 1:6055 NATHAN LN N STE 200
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1675
Mailing Address - Country:US
Mailing Address - Phone:763-513-4377
Mailing Address - Fax:763-248-7565
Practice Address - Street 1:1460 MONTREAL ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350
Practice Address - Country:US
Practice Address - Phone:320-587-2509
Practice Address - Fax:320-587-0283
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THRIFTY DRUG STORES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN265834OtherMN BOP
0311770084OtherMEDICARE
2434330OtherNCPDP
MN1790243046Medicaid
MN1790243046Medicaid