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NPI Code Detail

MEDICARE: RITE AID OF PENNSYLVANIA LLC

MEDICARE: RITE AID OF PENNSYLVANIA LLC
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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail PharmacyPP413687LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
33949419OTHEROTHER ID NUMBER

General Provider Information

NPI Number : 1518056266
Entity Type Code : Organization
Provider Name (Legal Business Name) : RITE AID OF PENNSYLVANIA LLC
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 : 910 WEST BROADWAY
Second Line :
City : RED LION
State : PA
Zip : 17356-1952
Country : US
Telephone Number : 717-244-2919
Fax Number :
Authorized Official
Title or Position : MANAGER ONLINE ADJUDICATION
Name : JENNIFER ZOREK
Credential :
Telephone Number : 717-975-5937
Provider Enumeration Date : 10/12/2006
Last Update Date : 08/07/2020

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Directions to “RITE AID OF PENNSYLVANIA LLC ” Practice Location

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