Rite Aid of Pennsylvania LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP415448L Issued in PA

Legal business name

RITE AID OF PENNSYLVANIA LLC

Doing business as

Rite Aid Pharmacy 04990

Practice address

2 Kirby Avenue
Mountain Top, PA 18707-1213

Phone

(570) 403-1132

NPI assigned

Oct 12, 2006

Organization subpart

No

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

Addresses

Other identifiers 3

Other names 1

• RITE AID PHARMACY 04990 Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 5

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

• Kimberly Ann Aldrich

  • Pharmacist
  • Mountain Top, PA
  • NPI 1992559785
  NPD (past)
• Kristina Marie Davis, PHARM.D.

  • Pharmacist
  • Mountain Top, PA
  • NPI 1942450788
  NPD (past)
• Matthew Kirk Kaster

  • Pharmacist
  • Mountain Top, PA
  • NPI 1447953591
  NPD (past)
• Gregory McFarlane, PHARM.D.

  • Pharmacist
  • Mountain Top, PA
  • NPI 1679049795
  NPD (past)
• Daniel Albert Nygren, RPH

  • Pharmacist
  • Dallas, PA
  • NPI 1871883108
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597622400000",
    "number": "1679662332",
    "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": "2 KIRBY AVENUE",
            "city": "MOUNTAIN TOP",
            "state": "PA",
            "postal_code": "187071213",
            "telephone_number": "570-403-1132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RITE AID OF PENNSYLVANIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2020-08-17",
        "certification_date": "2020-08-17",
        "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": "PA",
            "license": "PP415448L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "1007292980182",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007292980182",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3975046",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RITE AID PHARMACY 04990",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "RITE AID PHARMACY 04990",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lisa M Rainey, DO
• Michele Reilly-Miscavage, PHARM. D
• Heather M Reymunde Wittmer, MS, RDN
• Sandra Reynolds, CRNP
• Jordyn N Rickrode
• Arianna Catherine Roberts, CRNP
• Michael D Roberts, M.D
• Kiley Rogan, LPC
• Vladimir Russ, PHARMD
• Solomon Saul, D.O.

• Community/Retail Pharmacy in Mountain Top, PA
• Providers in Mountain Top, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 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.