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Provider Information for 1912017807


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RITE AID OF NEW YORK INC

Other Names:  
Doing Business As: 
RITE AID PHARMACY 03858

Organization Subpart: NO

NPI: 1912017807
Last Updated: 2011-10-06
Certification Date:

Details

NameValue
NPI1912017807
Enumeration Date2006-08-30
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 901 EAST GUN HILL ROAD
BRONX, NY 10469-3707
United States

Phone: 718-231-6677 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDNY01705453
Other (non-Medicare)3314793Other ID Number
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyNY023060