MEDICARE: MAXI DRUG SOUTH LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	PHA000284	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4105208	OTHER		OTHER ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013017441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXI DRUG SOUTH LP

Provider Business Mailing Address
First Line	:	200 NEWBERRY COMMONS
Second Line	:
City	:	ETTERS
State	:	PA
Zip	:	17319-9363
Country	:	US
Telephone Number	:	717-761-2633
Fax Number	:	717-975-8659

Provider Business Practice Location Address
First Line	:	1200 NORTH MAIN STREET
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02904-1820
Country	:	US
Telephone Number	:	401-272-3048
Fax Number	:

Authorized Official
Title or Position	:	MANAGER ONLINE ADJUDICATION
Name	:	JENNIFER ZOREK
Credential	:
Telephone Number	:	717-975-5937

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	12/13/2011

Similar Medicare Providers

1932266202 — NORTH PROVIDENCE SCHOOL DEPARTMENT
Practice Location Address:

1820 MINERAL SPRING AVENUE
NORTH PROVIDENCE, RI
02904

Practice Phone: 401-233-1104
Practice Fax: 401-233-1106

1770625501 — NORTH PROVIDENCE SCHOOL DEPARTMENT
Practice Location Address:

1820 MINERAL SPRING AVENUE
NORTH PROVIDENCE, RI
02904

Practice Phone: 401-233-1104
Practice Fax: 401-233-1106

1194015966 — DR. JESSICA LYNN LAMBRECHTS PHARM D
Practice Location Address:

1200 N MAIN ST
PROVIDENCE, RI
02904-1820

Practice Phone: 401-272-3048
Practice Fax:

1659661197 — MRS. JESSICA L ESPOSITO RPH
Practice Location Address:

1200 N MAIN ST
PROVIDENCE, RI
02904-1820

Practice Phone: 401-272-3048
Practice Fax: 401-621-1888

1174815344 — DR. HOLLY MARIE MATTOES PHARM.D.
Practice Location Address:

1200 N MAIN ST
PROVIDENCE, RI
02904-1820

Practice Phone: 401-272-3048
Practice Fax: 401-621-1888

1679709307 — MRS. GISELE POLANCO LCSW
Practice Location Address:

544 ELMWOOD AVE
PROVIDENCE, RI
02907-1820

Practice Phone: 401-781-2727
Practice Fax: 401-781-2828

Directions to “MAXI DRUG SOUTH LP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.