Organization
RITE AID OF PENNSYLVANIA LLC
Active
Organization
RITE AID OF PENNSYLVANIA LLC
Active
Other names
RITE AID PHARMACY 02587
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
3260 NORTH BROAD STREET, PHILADELPHIA, PA 19140-5008
(215) 225-9704
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
PP414325L
PA
3336C0003X
Community/Retail Pharmacy
Primary
PP414325L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007292981131
MEDICAID DME
PA
05
—
1007292981131
—
PA
01
—
3960235
OTHER ID NUMBER
—
Enumeration date
10/12/2006
Last updated
07/29/2020
Update your record
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