MEDICARE: RITE AID OF MARYLAND

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	3336C0003X	Community/Retail Pharmacy	P01067	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2112819	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	2112819	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1376652735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITE AID OF MARYLAND

Provider Business Mailing Address
First Line	:	200 NEWBERRY COMMONS
Second Line	:
City	:	ETTERS
State	:	PA
Zip	:	17319-9363
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	BOX HILL SQUARE SHOP CT
Second Line	:	2913 EMMORTON ROAD
City	:	ABINGDON
State	:	MD
Zip	:	21009-1631
Country	:	US
Telephone Number	:	410-569-1853
Fax Number	:	410-569-6022

Authorized Official
Title or Position	:	MANAGER ONLINE ADJUDICATION
Name	:	JENNIFER ZOREK
Credential	:
Telephone Number	:	717-975-5937

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	02/01/2008

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Directions to “RITE AID OF MARYLAND ” Practice Location

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