Provider Demographics
NPI:1982954129
Name:THRIFTY DRUG STORES, INC.
Entity Type:Organization
Organization Name:THRIFTY DRUG STORES, INC.
Other - Org Name:THRIFTY WHITE PHARMACY #781
Other - Org Type:Doing Business As
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:SUITE 200
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1674
Mailing Address - Country:US
Mailing Address - Phone:763-513-4300
Mailing Address - Fax:763-513-4380
Practice Address - Street 1:50 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1938
Practice Address - Country:US
Practice Address - Phone:218-643-3871
Practice Address - Fax:218-643-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPHAR578332B00000X
333600000X, 3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1982954129Medicaid
2136962OtherPK
MN265815OtherMN BOP
ND1455851 RXMedicaid
SD1982954129Medicaid
870000771Medicare PIN