MEDICARE: RITE AID OF NEW YORK INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	030904	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	3316242	OTHER	OTHER ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255420980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITE AID OF NEW YORK INC

Provider Business Mailing Address
First Line	:	200 NEWBERRY COMMONS
Second Line	:
City	:	ETTERS
State	:	PA
Zip	:	17319-9363
Country	:	US
Telephone Number	:	717-761-2633
Fax Number	:	717-975-8659

Provider Business Practice Location Address
First Line	:	76 PIKE STREET
Second Line	:
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-2414
Country	:	US
Telephone Number	:	845-856-8342
Fax Number	:

Authorized Official
Title or Position	:	SR MANAGER PROVIDER ENROLLMENT
Name	:	JENNIFER ZOREK
Credential	:
Telephone Number	:	717-975-5937

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/28/2014

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Directions to “RITE AID OF NEW YORK INC ” Practice Location

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