=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598836009
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITE AID OF MAINE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 03/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 223 NORTH STREET
-----------------------------------------------------
City | CALAIS
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04619-1619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-454-2262
-----------------------------------------------------
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 | MANAGER ONLINE ADJUDICATION
-----------------------------------------------------
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 | PH50001052
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------