Maxi Drug South LP

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHA00291 Issued in RI

Legal business name

MAXI DRUG SOUTH LP

Doing business as

Rite Aid Pharmacy 10250

Practice address

1764 Broad Street
Cranston, RI 02905-3519

Phone

(401) 461-6438

NPI assigned

Sep 22, 2006

Organization subpart

No

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

Addresses

Other identifiers 2

Other names 1

• RITE AID PHARMACY 10250 Doing business as

Practitioners 1

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

• Yvonne Boadih, PHARM.D

  • Pharmacist
  • Cranston, RI
  • NPI 1477727980
  NPD (past)

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237852800000",
    "number": "1235238601",
    "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": "1764 BROAD STREET",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029053519",
            "telephone_number": "401-461-6438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXI DRUG SOUTH LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2009-03-24",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "RI",
            "license": "PHA00291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "4105082",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD11340",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RITE AID PHARMACY 10250",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karen R Mathewson, OTR/L,CHT
• Joseph P. Matrullo, DMD
• Paul J. Matrullo, DDS
• John Esmat Matta, PHARMD
• Maxi Drug South LP (Rite Aid Pharmacy 10262)
• Maxi Drug South LP (Rite Aid Pharmacy 10254)
• Maxi Drug South LP (Rite Aid Pharmacy 10263)
• Maxi Drug South LP (Rite Aid Pharmacy 10261)
• Maxi Drug South LP (Rite Aid Pharmacy 06595)
• Julie Maxwell, MSOT

• Community/Retail Pharmacy in Cranston, RI
• Providers in Cranston, RI by specialty
• Community/Retail Pharmacy in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.