Organization
RITE AID OF PENNSYLVANIA LLC
Active
Other names
RITE AID PHARMACY 04676
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
407 CENTRAL AVENUE, JOHNSTOWN, PA 15902-2502
(814) 536-7596
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
PP410591L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007292980677
MEDICAID DME
PA
05
—
1007292980677
—
PA
01
—
3971795
OTHER ID NUMBER
—
Enumeration date
10/13/2006
Last updated
08/17/2020
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