MEDICARE: THRIFTY DRUG STORES INC

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	291U00000X	Clinical Medical Laboratory
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy
4	3336L0003X	Long Term Care Pharmacy
5	3336C0003X	Community/Retail Pharmacy	263225	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2116929	OTHER		PK

General Provider Information

NPI Number	:	1316194459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIFTY DRUG STORES INC

Provider Business Mailing Address
First Line	:	6701 EVENSTAD DR N STE 100
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-6013
Country	:	US
Telephone Number	:	763-513-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 LUNDORFF DR
Second Line	:
City	:	SANDSTONE
State	:	MN
Zip	:	55072-5099
Country	:	US
Telephone Number	:	320-245-5500
Fax Number	:	320-245-5123

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	TIMOTHY WEIPPERT
Credential	:
Telephone Number	:	763-585-3507

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	10/29/2024

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