MEDICARE: RITE AID

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5185155-1701	UT

General Provider Information

NPI Number	:	1528471588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITE AID

Provider Business Mailing Address
First Line	:	10223 S CALLA LILY WAY
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-4374
Country	:	US
Telephone Number	:	585-739-1906
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 IRON HORSE DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-5126
Country	:	US
Telephone Number	:	435-649-9621
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	SARAH JANE PRICE
Credential	:	RPH
Telephone Number	:	585-739-1906

Provider Enumeration Date	:	06/07/2014
Last Update Date	:	06/07/2014

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Directions to “RITE AID ” Practice Location

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