Rite Aid of Pennsylvania LLC
Organization Active NPI Community/Retail Pharmacy · Olyphant, PA
NPI 1700975448 · NPPES record last updated Aug 7, 2020
Key facts
- NPI
- 1700975448
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PP411254L (PA)
- Legal business name
- RITE AID OF PENNSYLVANIA LLC
- Practice address
- 1650 Main Street
Olyphant, PA 18447-1334 - Phone
- (570) 489-8834
- NPI assigned
- Oct 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Jennifer Zorek
- Title
- Manager Online Adjudication
- Phone
- (717) 975-5937
Practitioners 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050607000800 | PA | Part B Supplier - Mass Immunization (Roster Biller Only) | 1355384785 | This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
1650 Main St
Olyphant, PA 18447
Phone (570) 489-8834
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | PP411254L | PA | Yes |
Addresses
Primary practice location
1650 Main Street
Olyphant, PA 18447-1334
Mailing address
200 Newberry Commons
Etters, PA 17319-9363
Phone (717) 761-2633
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1007292980419 | Other | PA | MEDICAID DME |
| 1007292980419 | Medicaid | PA | |
| 3946956 | Other | OTHER ID NUMBER |
Other names
- RITE AID PHARMACY 01426
Other providers in Olyphant, PA
- Joseph Gary Pruzinsky
- Eric Michael Pusey
- Rebar Dental
- Krista Marie Rebar
- Stephen M. Rebar
- Brianne Roberts
- Roseann Marie Rupp-Maiolatesi
- Samir B Pancholy LLC
- Emilia Ivanova Slavova
- Stanley Joseph Solack
All providers in Olyphant, PA · Community/Retail Pharmacy in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2020. 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.