MEDICARE: RITE AID OF OHIO 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	02186650	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3639436	OTHER		NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831105147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITE AID OF OHIO 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	:	1915 CENTRAL AVE
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-4401
Country	:	US
Telephone Number	:	513-420-2546
Fax Number	:

Authorized Official
Title or Position	:	SR MANAGER THIRD PARTY ENROLLMENTS
Name	:	JENNIFER M ZOREK
Credential	:
Telephone Number	:	717-975-5937

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	02/07/2014

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