Eckerd Corporation – Community/Retail Pharmacy

Key facts

NPI: 1205935533
Entity type: Organization (NPI type 2)
Primary specialty: Community/Retail Pharmacy 3336C0003X
License: 201004023 (VA)
Legal business name: ECKERD CORPORATION
Practice address: 1808 Salem Road
Virginia Beach, VA 23456-1393
Phone: (757) 471-1053
NPI assigned: Sep 22, 2006
Organization subpart: No

Authorized official

Name: Jennifer Zorek
Title: Manager Online Adjudication
Phone: (717) 975-5937

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Declan Aidan Burke, PHARMACY TECHNICIAN Pharmacy Technician · Virginia Beach, VA · NPI 1720780752

NPD (past)
Jackson Crouse Pharmacist · Virginia Beach, VA · NPI 1104590140

NPD (past)
Lee James Euston, RPH Pharmacist · Virginia Beach, VA · NPI 1851604094

NPD (past)
John Anthony Forte III, PHARM D., RPH Pharmacist · Virginia Beach, VA · NPI 1679097562

NPD (past)
Margaret Walker, MARGARET WALKER Pharmacist · Virginia Beach, VA · NPI 1245550318

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Enrolled in VA

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20080125000213	VA	Part B Supplier - Mass Immunization (Roster Biller Only)	4082699152	This NPI is an additional NPI on the enrollment Practice locations: Virginia Beach, VA; Chesapeake, VA; Suffolk, VA; Poquoson, VA; Norfolk, VA; Lawrenceville, VA; Hampton, VA

National Provider Directory

Locations

1808 Salem Rd
Virginia Beach, VA 23456
Phone (757) 471-1053

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Durable Medical Equipment & Medical Supplies	332B00000X
Community/Retail Pharmacy	3336C0003X	201004023	VA	Yes

Addresses

Primary practice location

1808 Salem Road
Virginia Beach, VA 23456-1393

Mailing address

200 Newberry Commons
Etters, PA 17319-9363
Phone (717) 761-2633

Other identifiers

Identifier	Type	State	Issuer
010149029	Medicaid	VA
4838439	Other		OTHER ID NUMBER-COMMERCIAL NUMBER

Other names

RITE AID PHARMACY 11271 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 11, 2011.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318291200000",
    "number": "1205935533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NEWBERRY COMMONS",
            "city": "ETTERS",
            "state": "PA",
            "postal_code": "173199363",
            "telephone_number": "717-761-2633",
            "fax_number": "717-975-8659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 SALEM ROAD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234561393",
            "telephone_number": "757-471-1053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ECKERD CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2011-10-11",
        "status": "A",
        "authorized_official_last_name": "ZOREK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "MANAGER ONLINE ADJUDICATION",
        "authorized_official_telephone_number": "717-975-5937"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": "201004023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010149029",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4838439",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RITE AID PHARMACY 11271",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Virginia Beach, VA

All providers in Virginia Beach, VA · Community/Retail Pharmacy in Virginia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2011. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.