Healthcare Provider Details

I. General information

NPI: 1295844504
Provider Name (Legal Business Name): THRIFTY PAYLESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22631 BOTHELL WAY SOUTHEAST CANYON PARK SHOPPING CENTER
BOTHELL WA
98021-8401
US

IV. Provider business mailing address

200 NEWBERRY COMMONS
ETTERS PA
17319-9363
US

V. Phone/Fax

Practice location:
  • Phone: 425-481-8667
  • Fax:
Mailing address:
  • Phone: 717-761-2633
  • Fax: 717-975-8659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number262010402033
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6017263
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
Identifier4914556
Identifier TypeOTHER
Identifier State
Identifier IssuerOTHER ID NUMBER

VIII. Authorized Official

Name: JENNIFER ZOREK
Title or Position: MANAGER ONLINE ADJUDICATION
Credential:
Phone: 717-975-5937