Organization
EDC DRUG STORES
Active
Other names
RITE AID PHARMACY 11536
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
380 WESTERN BOULEVARD, JACKSONVILLE, NC 28546-6347
(910) 353-3424
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
8678
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0675553
—
NC
01
—
3418921
NCPDP
—
01
—
7702459
MEDICAID DME
NC
Enumeration date
09/22/2006
Last updated
03/25/2015
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