Organization
ECKERD CORPORATION
Active
Other names
RITE AID PHARMACY 11297
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
5914 WEST HIGH STREET, PORTSMOUTH, VA 23703-4506
(757) 484-8400
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
201000876
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008509832
—
VA
05
—
0139678006
—
WV
01
—
1295834414
MEDICAID DME
VA
01
—
4830635
NCPDP
—
Enumeration date
09/22/2006
Last updated
10/11/2011
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