Active NPI
Maxi Drug Inc
- Community/Retail Pharmacy
- Northford, CT
National Provider Identifier
1902906332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 1459
- Legal business name
- MAXI DRUG INC
- Practice address
- 1395 Middletown Avenue
Northford, CT 06472-1395 - Phone
- (203) 484-0432
- NPI assigned
- Sep 25, 2006
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 1459 | CT | Primary |
Addresses
Primary practice location
1395 Middletown Avenue
Northford, CT 06472-1395
Mailing address
200 Newberry Commons
Etters, PA 17319-9363
Phone (717) 761-2633
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004137007 | Medicaid | CT | |
| 004244696 | Other | CT | MEDICAID DME |
| 0715877 | Other | NCPDP |
Other names 1
- RITE AID PHARMACY 10372
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200522000778 | CT | Part B Supplier - Pharmacy | 0042254898 |
11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bethel, CT; Cheshire, CT; Fairfield, CT; Hamden, CT; Milford, CT; Monroe, CT; North Branford, CT; Northford, CT… |
Other NPIs on the same Medicare enrollment 11
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
1395 Middletown Ave
Northford, CT 06472
Phone (203) 484-0431
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1329091200000",
"number": "1902906332",
"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": "1395 MIDDLETOWN AVENUE",
"city": "NORTHFORD",
"state": "CT",
"postal_code": "064721395",
"telephone_number": "203-484-0432"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MAXI DRUG INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-25",
"last_updated": "2012-02-13",
"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": "CT",
"license": "1459",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004137007",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID DME",
"identifier": "004244696",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "0715877",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "RITE AID PHARMACY 10372",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Northford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2012; 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.