Organization
RITE AID OF NEW YORK INC
Active
Other names
RITE AID PHARMACY 00742
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (SR MANAGER PROVIDER ENROLLMENT)
(717) 975-5937
Entity
Organization
Contact information
Practice address
76 PIKE STREET, PORT JERVIS, NY 12771-2414
(845) 856-8342
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
030904
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00315875
—
NY
01
—
1007631000017
PA MEDICAID
PA
01
—
3316242
OTHER ID NUMBER
—
Enumeration date
10/12/2006
Last updated
07/28/2014
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