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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 Supplies
23336C0003XCommunity/Retail PharmacyPP413455LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23908730OTHEROTHER ID NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114016854
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 : 11750 BUSTLETON AVENUE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19116-2516
Country : US
Telephone Number : 215-934-6221
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 : 08/07/2020

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Directions to “RITE AID OF PENNSYLVANIA LLC ” Practice Location

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