Provider Demographics
NPI:1619065034
Name:ECKERD CORPORATION
Entity Type:Organization
Organization Name:ECKERD CORPORATION
Other - Org Name:RITE AID PHARMACY 10733
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OL ADJUDICATION
Authorized Official - Prefix:
Authorized Official - First Name:JENNI
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 1:5335 WEST GENESEE STREET
Practice Address - Street 2:SUITE 20
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2265
Practice Address - Country:US
Practice Address - Phone:315-487-0435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00479218OtherMEDICAID DME
3327827OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY00479218Medicaid
NY00479218OtherMEDICAID DME
NYP00946560Medicare PIN
NYJ300020460Medicare PIN