NPIMap

Organization Active NPI

Rite Aid of Pennsylvania LLC

Doing business as Rite Aid Pharmacy 04791

  • Community/Retail Pharmacy
  • Williamsport, PA
National Provider Identifier
1306936323
Registry record updated Jun 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PP414514L Issued in PA
Legal business name
RITE AID OF PENNSYLVANIA LLC
Doing business as
Rite Aid Pharmacy 04791
Practice address
2023 Lycoming Creek Road
Williamsport, PA 17701-1206
Phone
(570) 327-9920
NPI assigned
Oct 13, 2006
Last updated
Jun 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer ZorekNPI 1205649464
Title
Manager Online Adjudication
Phone
(717) 975-5937

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X PP414514L PA Primary

Addresses

Primary practice location

2023 Lycoming Creek Road
Williamsport, PA 17701-1206

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
1007292981075MedicaidPA
3972773OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1007292981075OtherPAMEDICAID DME

Other names 1

  • RITE AID PHARMACY 04791 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050607000800 PA Part B Supplier - Mass Immunization (Roster Biller Only) 1355384785 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Locations

2023 Lycoming Creek Rd
Williamsport, PA 17701
Phone (570) 327-9920

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592956800000",
    "number": "1306936323",
    "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": "2023 LYCOMING CREEK ROAD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011206",
            "telephone_number": "570-327-9920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RITE AID OF PENNSYLVANIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP414514L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007292981075",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3972773",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "1007292981075",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RITE AID PHARMACY 04791",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "RITE AID PHARMACY 04791",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamsport, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare 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.