Provider Demographics
NPI:1720197007
Name:RITE AID OF DELAWARE INC
Entity Type:Organization
Organization Name:RITE AID OF DELAWARE INC
Other - Org Name:RITE AID PHARMACY 01294
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER ONLINE ADJUDICATION
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 1:636 SOUTH MARYLAND AVENUE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-1632
Practice Address - Country:US
Practice Address - Phone:302-994-3473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
DEA300004813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000139007Medicaid
0802240OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0802240OtherOTHER ID NUMBER-COMMERCIAL NUMBER
6090420007Medicare NSC
DE162846Medicare PIN