Organization
RITE AID OF PENNSYLVANIA LLC
Active
Other names
RITE AID PHARMACY 01854
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER M ZOREK (SR MANAGER THIRD PARTY ENROLLMENTS)
(717) 975-5937
Entity
Organization
Contact information
Practice address
1709 LIBERTY STREET, ERIE, PA 16502-1650
(814) 452-2596
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
PP410081L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007292980599
MEDICAID DME
PA
05
—
1007292980599
—
PA
05
—
2603294
—
OH
01
—
3953014
OTHER ID NUMBER
—
Enumeration date
10/12/2006
Last updated
04/07/2020
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