Provider Demographics
NPI:1982107355
Name:THRIFTY DRUG STORES, INC.
Entity Type:Organization
Organization Name:THRIFTY DRUG STORES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
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:STE 200
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1674
Mailing Address - Country:US
Mailing Address - Phone:763-513-4370
Mailing Address - Fax:
Practice Address - Street 1:221 KENNEDY MEMORIAL DR
Practice Address - Street 2:STE A
Practice Address - City:HOYT LAKES
Practice Address - State:MN
Practice Address - Zip Code:55750-1141
Practice Address - Country:US
Practice Address - Phone:218-225-2128
Practice Address - Fax:218-225-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336L0003X, 3336S0011X
MN265548333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176477OtherPK
MN1982107355Medicaid