=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629510854
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THRIFTY DRUG STORES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2016
-----------------------------------------------------
Last Update Date | 10/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2018 15TH ST NW
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-0716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-281-1676
-----------------------------------------------------
Fax | 507-281-2953
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6701 EVENSTAD DR N STE 100
-----------------------------------------------------
City | MAPLE GROVE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55369-6013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-513-4300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | TIMOTHY WEIPPERT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 763-585-3507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 265196
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------