Organization
EDC DRUG STORES
Active
Other names
RITE AID PHARMACY 11535
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
622 NORTH MARINE BOULEVARD, JACKSONVILLE, NC 28540-6142
(910) 455-2911
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
8677
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0675546
—
NC
01
—
3402396
NCPDP
—
01
—
7702339
MEDICAID DME
NC
Enumeration date
09/22/2006
Last updated
03/04/2013
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