NPIMap

Organization Active NPI

Thrifty Payless Inc

  • Community/Retail Pharmacy
  • Victorville, CA
National Provider Identifier
1205923562
Registry record updated Oct 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY48263 Issued in CA
Legal business name
THRIFTY PAYLESS INC
Practice address
14515 Mojave Drive
Suite B
Victorville, CA 92394-6720
Phone
(760) 955-7898
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Zorek
Title
Manager Online Adjudication
Phone
(717) 975-5937

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X PHY48263 CA
Community/Retail Pharmacy 3336C0003X PHY48263 CA Primary

Addresses

Primary practice location

14515 Mojave Drive
Suite B
Victorville, CA 92394-6720

Mailing address

200 Newberry Commons
Etters, PA 17319-9363
Phone (717) 761-2633

Other identifiers 2

IdentifierTypeStateIssuer
5623992OtherCANCPDP
PHA482630MedicaidCA

Other names 1

  • RITE AID PHARMACY 06473 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110309000350 CA Part B Supplier - Mass Immunization (Roster Biller Only) 7719979095 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Locations

14515 Mojave Dr
Ste B
Victorville, CA 92394
Phone (760) 955-7898

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319414400000",
    "number": "1205923562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NEWBERRY COMMONS",
            "city": "ETTERS",
            "state": "PA",
            "postal_code": "173199363",
            "telephone_number": "717-761-2633",
            "fax_number": "717-975-8659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14515 MOJAVE DRIVE",
            "address_2": "SUITE B",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923946720",
            "telephone_number": "760-955-7898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THRIFTY PAYLESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2011-10-24",
        "status": "A",
        "authorized_official_last_name": "ZOREK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "MANAGER ONLINE ADJUDICATION",
        "authorized_official_telephone_number": "717-975-5937"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "PHY48263",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY48263",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "5623992",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA482630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RITE AID PHARMACY 06473",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.