Provider Demographics
NPI:1114036415
Name:RITE AID OF VIRGINIA INC
Entity Type:Organization
Organization Name:RITE AID OF VIRGINIA INC
Other - Org Name:RITE AID PHARMACY 00764
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-975-5937
Mailing Address - Street 1:200 NEWBERRY COMMONS
Mailing Address - Street 2:
Mailing Address - City:ETTERS
Mailing Address - State:PA
Mailing Address - Zip Code:17319-9363
Mailing Address - Country:US
Mailing Address - Phone:717-761-2633
Mailing Address - Fax:717-975-8659
Practice Address - Street 1:5210 OAKLAWN BOULEVARD
Practice Address - Street 2:THE CROSSINGS
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-7336
Practice Address - Country:US
Practice Address - Phone:804-458-8688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X, 332B00000X
VA02010012613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No291U00000XLaboratoriesClinical Medical Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4803640OtherOTHER ID NUMBER-COMMERCIAL NUMBER
VA008509913Medicaid
VAP00920219Medicare PIN
4803640OtherOTHER ID NUMBER-COMMERCIAL NUMBER
VA008509913Medicaid