Healthcare Provider Details

I. General information

NPI: 1801320197
Provider Name (Legal Business Name): THRIFTY DRUG STORES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 S POKEGAMA AVE
GRAND RAPIDS MN
55744-2503
US

IV. Provider business mailing address

6701 EVENSTAD DR N STE 100
MAPLE GROVE MN
55369-6013
US

V. Phone/Fax

Practice location:
  • Phone: 763-585-3507
  • Fax:
Mailing address:
  • Phone: 763-513-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY WEIPPERT
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 763-513-4365