MEDICARE: RITE AID OF NEW JERSEY INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	RSO2856	NJ

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3121768	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1437268851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITE AID OF NEW JERSEY INC

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	:	907 NORTH HIGH STREET
Second Line	:
City	:	MILLVILLE
State	:	NJ
Zip	:	08332-3762
Country	:	US
Telephone Number	:	856-825-7742
Fax Number	:

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	:	08/16/2011

907 N HIGH ST
MILLVILLE, NJ
08332-3762

Practice Phone: 856-825-7742
Practice Fax: 856-825-2462

907 N HIGH ST
MILLVILLE, NJ
08332-3762