=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407966393
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITE AID OF MICHIGAN INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 02/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2410 BURTON ST SE
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-949-5710
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 NEWBERRY COMMONS
-----------------------------------------------------
City | ETTERS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17319-9363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-761-2633
-----------------------------------------------------
Fax | 717-975-8659
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR MANAGER
-----------------------------------------------------
Name | JENNIFER ZOREK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-975-5937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 4019
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------