Provider Demographics
NPI:1124317490
Name:THRIFTY DRUG STORES INC
Entity type:Organization
Organization Name:THRIFTY DRUG STORES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-585-3507
Mailing Address - Street 1:6701 EVENSTAD DR N STE 100
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-6013
Mailing Address - Country:US
Mailing Address - Phone:763-513-4300
Mailing Address - Fax:
Practice Address - Street 1:706 38TH ST N
Practice Address - Street 2:UNIT A
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2953
Practice Address - Country:US
Practice Address - Phone:701-893-9183
Practice Address - Fax:701-893-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
MN2629103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
2129845OtherPK