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	71584	CA

General Provider Information

NPI Number	:	1922402072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITE AID

Provider Business Mailing Address
First Line	:	1411 KETTNER BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 KETTNER BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2420
Country	:	US
Telephone Number	:	619-231-7405
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	JULIE QUACH
Credential	:
Telephone Number	:	619-231-7405

Provider Enumeration Date	:	10/18/2014
Last Update Date	:	10/18/2014

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Directions to “RITE AID ” Practice Location

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