Organization · NPI-2
Rite Aid Of New York INC
Pharmacy, Community/Retail Pharmacy · Port Jervis, NY
NPI number1255420980
StatusActive
Last updated in NPPESJul 28, 2014
Details
- NPI
- 1255420980
- Entity type
- Organization (NPI-2)
- Legal business name
- Rite Aid Of New York INC
- Organization subpart
- No
- Enumeration date
- Oct 12, 2006
- Last updated
- Jul 28, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | 030904 | NY | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – |
Other names
- Rite Aid Pharmacy 00742 (Doing Business As)
Practice location
76 Pike StreetPort Jervis, NY 12771-2414
Phone 845-856-8342
Mailing address
200 Newberry CommonsEtters, PA 17319-9363
Phone 717-761-2633 · Fax 717-975-8659
Authorized official
Jennifer Zorek
Sr Manager Provider Enrollment
7179755937
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