MEDICARE: THRIFTY PAYLESS INC

Medicare Provider Information

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	PH1237	NV

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2904387	OTHER	NCPDP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1821107210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIFTY PAYLESS INC

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	:	1329 US HIGHWAY 395 NORTH
Second Line	:	SUITE 1
City	:	GARDNERVILLE
State	:	NV
Zip	:	89410-5391
Country	:	US
Telephone Number	:	775-782-7042
Fax Number	:

Authorized Official
Title or Position	:	SR MANAGER THIRD PARTY ENROLLMENTS
Name	:	JENNIFER M ZOREK
Credential	:
Telephone Number	:	717-975-5937

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	10/17/2012

1329 US HIGHWAY 395 N , #1
GARDNERVILLE, NV
89410-5391

Practice Phone: 775-782-7042
Practice Fax: