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Provider Information for 1255440731


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RITE AID OF NEW YORK INC

Other Names:  
Doing Business As: 
RITE AID PHARMACY 03983

Organization Subpart: NO

NPI: 1255440731
Last Updated: 2012-01-04
Certification Date:

Details

NameValue
NPI1255440731
Enumeration Date2006-08-29
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: JENNIFER ZOREK
Title: MANAGER ONLINE ADJUDICATION
Phone: 7179755937
Mailing Address 200 NEWBERRY COMMONS
ETTERS, PA 17319-9363
United States

Phone: 717-761-2633 | Fax:717-975-8659
 
Primary Practice Address 338 WEST WASHINGTON STREET
BATH, NY 14810-1024
United States

Phone: 607-776-4747 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDNY01790041
Other (non-Medicare)3328312Other ID Number
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyNY023477