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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 SuppliesPP414325LPA
23336C0003XCommunity/Retail PharmacyPP414325LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23960235OTHEROTHER ID NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720177470
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 : 3260 NORTH BROAD STREET
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-5008
Country : US
Telephone Number : 215-225-9704
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 : 07/29/2020

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Directions to “RITE AID OF PENNSYLVANIA LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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