Healthcare Provider Details

I. General information

NPI: 1205850559
Provider Name (Legal Business Name): RITE AID OF MICHIGAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 EAST GRAND RIVER AVENUE
PORTLAND MI
48875-1629
US

IV. Provider business mailing address

200 NEWBERRY COMMONS
ETTERS PA
17319-9363
US

V. Phone/Fax

Practice location:
  • Phone: 517-647-4704
  • Fax:
Mailing address:
  • Phone: 717-761-2633
  • Fax: 717-975-8659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301006502
License Number StateMI

VIII. Authorized Official

Name: JENNIFER ZOREK
Title or Position: MANAGER ONLINE ADJUDICATION
Credential:
Phone: 717-975-5937