Organization
PERRY DRUG STORES INC AND SUBSIDIARIES
Active
Other names
RITE AID PHARMACY 04543
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (SR MA NAGER PROVIDER ENROLLMENT)
(717) 975-5937
Entity
Organization
Contact information
Practice address
22501 MICHIGAN AVENUE, DEARBORN, MI 48124-2122
(313) 278-1515
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5355
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2346648
OTHER ID NUMBER
—
05
—
2346648
—
MI
Enumeration date
08/29/2006
Last updated
06/26/2014
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