Rite Aid of New York Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

020938 Issued in NY

Legal business name

RITE AID OF NEW YORK INC

Practice address

73 North Main Street
Big M Shopping Center
Brockport, NY 14420-1648

Phone

(585) 637-1151

NPI assigned

Aug 30, 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 2

Other names 1

• RITE AID PHARMACY 02674 Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

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

• Kimberly Anne Wildermuth, PHARMD

  • Pharmacist
  • Brockport, NY
  • NPI 1407039449
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325116800000",
    "number": "1740399070",
    "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": "73 NORTH MAIN STREET",
            "address_2": "BIG M SHOPPING CENTER",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201648",
            "telephone_number": "585-637-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RITE AID OF NEW YORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2011-12-29",
        "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": "020938",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3398511",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01259003",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RITE AID PHARMACY 02674",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kourtney Reed, LMSW
• Alison Elizabeth Reigle, MS
• Danielle Renodin-Mead, DO
• Alicia Marie Rich, OPTICIAN
• John P Risolo, M.D.
• Robyn Rode-Holbrook, LPN
• Cynthia Jane Rombaut, FNP
• Igor Wladimir Rosien, M.D.
• Bethany Robin Roth, LMSW
• Terry N. Russell

• Community/Retail Pharmacy in Brockport, NY
• Providers in Brockport, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2011; 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.