Organization
ECKERD CORPORATION
Active
Other names
RITE AID PHARMACY 11404
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
200 NORTH LASALLE STREET, DURHAM, NC 27705-3013
(919) 383-5591
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
8624
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0326256
—
NC
01
—
3400683
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
7702484
MEDICAID DME
NC
05
—
7N9636
—
SC
Enumeration date
09/26/2006
Last updated
08/08/2011
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