Organization
RITE AID OF PENNSYLVANIA LLC
Active
Organization
RITE AID OF PENNSYLVANIA LLC
Active
Other names
RITE AID PHARMACY 02248
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
639 HAMLIN HIGHWAY, LAKE ARIEL, PA 18436-0000
(570) 689-4660
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
PP414269L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007292980016
PA MEDICAID-BEFORE RELO
PA
01
—
1007292981159
DME
PA
05
—
1007292981159
—
PA
01
—
3959256
OTHER ID NUMBER
—
Enumeration date
10/13/2006
Last updated
08/11/2020
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