Organization Active NPI

Rite Aid of Michigan Inc

  • Community/Retail Pharmacy
  • Traverse City, MI
National Provider Identifier
1508876053
Registry record updated Oct 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301006477 Issued in MI
Legal business name
RITE AID OF MICHIGAN INC
Practice address
939 US Highway 31 South
Traverse City, MI 49684-8019
Phone
(231) 943-9288
NPI assigned
Aug 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2008

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

Authorized official

Name
Jennifer M Zorek
Title
Manager Ol Adjudication
Phone
(717) 975-5937

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 5301006477 MI
Community/Retail Pharmacy 3336C0003X 5301006477 MI Primary

Addresses

Primary practice location

939 US Highway 31 South
Traverse City, MI 49684-8019

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
2356093MedicaidMI
2356093OtherMINCPDP

Other names 1

  • Rite Aid Pharmacy 04276 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050902000356 MI Part B Supplier - Mass Immunization (Roster Biller Only) 0840222501 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Locations

939 US Highway 31 S
Traverse City, MI 49685
Phone (231) 943-9288

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223251200000",
    "number": "1508876053",
    "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": "939 US HIGHWAY 31 SOUTH",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496848019",
            "telephone_number": "231-943-9288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RITE AID OF MICHIGAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2008-10-06",
        "status": "A",
        "authorized_official_last_name": "ZOREK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGER OL ADJUDICATION",
        "authorized_official_telephone_number": "717-975-5937"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "5301006477",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301006477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2356093",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2356093",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rite Aid Pharmacy 04276",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2008; 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.