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	PHY44073	CA
2	3336C0003X	Community/Retail Pharmacy	PHY44073	CA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0545395	OTHER	CA	NCPDP

NPI Number	:	1972525889
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	:	5670 EAST SECOND STREET
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3904
Country	:	US
Telephone Number	:	562-930-1280
Fax Number	:

Authorized Official
Title or Position	:	MANAGER ONLINE ADJUDICATION
Name	:	JENNIFER ZOREK
Credential	:
Telephone Number	:	717-975-5937

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	10/26/2011

5610 E 2ND ST
LONG BEACH, CA
90803-3904

Practice Phone: 562-434-7775
Practice Fax: 562-433-3119