MEDICARE: RITE AID PHARMACY

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

General Provider Information

NPI Number	:	1861867681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITE AID PHARMACY

Provider Business Mailing Address
First Line	:	1464 S GREENMOUNT DR
Second Line	:	APT #107
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-2307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5741 SILVER HILL RD
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-1102
Country	:	US
Telephone Number	:	301-736-0904
Fax Number	:

Authorized Official
Title or Position	:	PHARMACID
Name	:	MUSA ABDULAHI
Credential	:	PHARMD
Telephone Number	:	404-697-2335

Provider Enumeration Date	:	12/04/2015
Last Update Date	:	12/04/2015

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