Organization
ECKERD CORPORATION
Active
Other names
RITE AID PHARMACY 11082
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
801 GROW AVENUE, MONTROSE, PA 18801
(570) 278-9602
Mailing address
200 NEWBERRY COMMONS, ETTERS, PA 17319-9363
(717) 761-2633
(717) 975-8659
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PP414289L
PA
3336C0003X
Community/Retail Pharmacy
Primary
PP414289L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007308150252
MEDICAID DME
PA
05
—
1007308150261
—
PA
01
—
3961477
OTHER ID NUMBER
—
Enumeration date
09/25/2006
Last updated
11/22/2011
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