Organization
EDC DRUG STORES
Active
Other names
RITE AID PHARMACY 11528
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER OL ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
4600- 2 MAIN STREET, SHALLOTTE, NC 28459-0000
(910) 754-7570
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0105304
—
NC
01
—
3422944
OTHER ID NUMBER COMMERCIAL NUMBER
—
01
—
7702367
MEDICAID DME
NC
Enumeration date
09/22/2006
Last updated
10/13/2014
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