Rite Aid of New York Inc – Community/Retail Pharmacy

Key facts

NPI: 1679682108
Entity type: Organization (NPI type 2)
Primary specialty: Community/Retail Pharmacy 3336C0003X
License: 022660 (NY)
Legal business name: RITE AID OF NEW YORK INC
Practice address: 741 Columbus Avenue
New York, NY 10025-6461
Phone: (212) 316-0436
NPI assigned: Aug 29, 2006
Organization subpart: No

Authorized official

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

Practitioners 8

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

Samantha Christina Bacarella, PHARMD Pharmacist · New York, NY · NPI 1861155103

NPD (past)
Dalia N Boulos, R.PH Pharmacist · New York, NY · NPI 1932381027

NPD (past)
Dongsook Choi Pharmacist · New York, NY · NPI 1477738938

NPD (past)
Afsha Gouse, PHARMD Pharmacist · New York, NY · NPI 1760056519

NPD (past)
Sarah Ran Lee Pharmacist · New York, NY · NPI 1760964092

NPD (past)
Robert NG Pharmacist · New York, NY · NPI 1497285803

NPD (past)
James Vito Pietroforte Pharmacist · New York, NY · NPI 1861676512

NPD (past)
David P Su, PHARMD Pharmacist · New York, NY · NPI 1851818694

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NY

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20100820000438	NY	Part B Supplier - Mass Immunization (Roster Biller Only)	6800920273	This NPI is an additional NPI on the enrollment

National Provider Directory

Locations

741 Columbus Ave
New York, NY 10025
Phone (212) 316-0436

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Durable Medical Equipment & Medical Supplies	332B00000X
Community/Retail Pharmacy	3336C0003X	022660	NY	Yes

Addresses

Primary practice location

741 Columbus Avenue
New York, NY 10025-6461

Mailing address

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

Other identifiers

Identifier	Type	State	Issuer
01588898	Medicaid	NY
3307205	Other		OTHER ID NUMBER

Other names

RITE AID PHARMACY 04189 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 6, 2011.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317859200000",
    "number": "1679682108",
    "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": "741 COLUMBUS AVENUE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100256461",
            "telephone_number": "212-316-0436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RITE AID OF NEW YORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2011-10-06",
        "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": "NY",
            "license": "022660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01588898",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3307205",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RITE AID PHARMACY 04189",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

All providers in New York, NY · Community/Retail Pharmacy in New York

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 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.