Provider Demographics
NPI:1013089705
Name:THRIFTY DRUG STORES INC
Entity Type:Organization
Organization Name:THRIFTY DRUG STORES INC
Other - Org Name:THRIFTY WHITE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VICE PRESIDENT PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-513-4357
Mailing Address - Street 1:PO BOX 46040
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-0040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHBY
Practice Address - State:MN
Practice Address - Zip Code:56309-4687
Practice Address - Country:US
Practice Address - Phone:218-747-2988
Practice Address - Fax:218-747-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2629213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21527Medicaid
2427816OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MN186925100Medicaid
ND21527Medicaid
0311770056Medicare NSC