MEDICARE: RITEAID

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	302R00000X	Health Maintenance Organization	28RI02375600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28RI02375600	OTHER	NJ	PHARMACIST

General Provider Information

NPI Number	:	1861627895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITEAID

Provider Business Mailing Address
First Line	:	265 PASCACK RD
Second Line	:
City	:	TOWNSHIP OF WASHINGTON
State	:	NJ
Zip	:	07676-4809
Country	:	US
Telephone Number	:	201-665-5289
Fax Number	:	201-664-5298

Provider Business Practice Location Address
First Line	:	265 PASCACK RD
Second Line	:
City	:	TOWNSHIP OF WASHINGTON
State	:	NJ
Zip	:	07676-4809
Country	:	US
Telephone Number	:	201-665-5289
Fax Number	:	201-664-5298

Authorized Official
Title or Position	:	CLINICAL MANAGER
Name	:	MISS AMANDA GLOVER
Credential	:	RPH
Telephone Number	:	717-975-8676

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	05/19/2009

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Directions to “RITEAID ” Practice Location

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