Rite Aid of New York Inc

Organization Active NPI Community/Retail Pharmacy · Chittenango, NY

NPI 1992814461 · NPPES record last updated Dec 28, 2011

Key facts

NPI
1992814461
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
013173 (NY)
Legal business name
RITE AID OF NEW YORK INC
Practice address
1365 West Genesee Street
Chittenango, NY 13037-8505
Phone
(315) 687-3841
NPI assigned
Aug 29, 2006
Organization subpart
No

Authorized official

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NY

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100820000438 NY Part B Supplier - Mass Immunization (Roster Biller Only) 6800920273 This NPI is an additional NPI on the enrollment

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 013173 NY Yes

Addresses

Primary practice location

1365 West Genesee Street
Chittenango, NY 13037-8505

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
3316115OtherOTHER ID NUMBER
RI1002983MedicaidVT
00487792MedicaidNY

Other names

  • RITE AID PHARMACY 00655 Doing business as

Other providers in Chittenango, NY

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

Sources for this page

Verify at the official NPI Registry.