Provider Demographics
NPI:1528420130
Name:RITE AID OF VIRGINIA INC
Entity Type:Organization
Organization Name:RITE AID OF VIRGINIA INC
Other - Org Name:RITE AID PHARMACY 06744
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR MANAGER PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOREKQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-975-5937
Mailing Address - Street 1:200 NEWBERRY CMNS
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:717-975-5937
Mailing Address - Fax:717-975-8659
Practice Address - Street 1:6150 COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1234
Practice Address - Country:US
Practice Address - Phone:757-638-2912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1528420130Medicaid
VAP00920219OtherRR PTAN #
4847046OtherNCPDP
VA1528420130Medicaid
5781150131Medicare NSC
4847046OtherNCPDP