Active NPI
Rite Aid of Michigan Inc
- Community/Retail Pharmacy
- Port Huron, MI
National Provider Identifier
1679585376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 5390
- Legal business name
- RITE AID OF MICHIGAN INC
- Practice address
- 2910 Pine Grove Avenue
Port Huron, MI 48060-1976 - Phone
- (810) 987-3663
- NPI assigned
- Aug 12, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jennifer Zorek
- Title
- Manager Online Adjudication
- Phone
- (717) 975-5937
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 5390 | MI | Primary |
Addresses
Primary practice location
2910 Pine Grove Avenue
Port Huron, MI 48060-1976
Mailing address
200 Newberry Commons
Etters, PA 17319-9363
Phone (717) 761-2633
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2347018 | Other | OTHER ID NUMBER | |
| 2347018 | Medicaid | MI |
Other names 1
- RITE AID PHARMACY 04574
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050725000709 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 1153358833 |
8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ionia, MI; Ludington, MI; Manistee, MI; Petoskey, MI; Sault St Marie, MI; St Johns, MI; Traverse City, MI |
| O20050902000356 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 0840222501 | This NPI is an additional NPI on the enrollment |
Other NPIs on the same Medicare enrollment 8
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
2910 Pine Grove Ave
Port Huron, MI 48060
Phone (810) 987-3663
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1239926400000",
"number": "1679585376",
"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": "2910 PINE GROVE AVENUE",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480601976",
"telephone_number": "810-987-3663"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RITE AID OF MICHIGAN INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-12",
"last_updated": "2009-04-17",
"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": "MI",
"license": "5390",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER",
"identifier": "2347018",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2347018",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "RITE AID PHARMACY 04574",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Port Huron, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2009; 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.