Healthcare Provider Details

I. General information

NPI: 1780004804
Provider Name (Legal Business Name): RITE AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 BARSTOW RD
BARSTOW CA
92311-4944
US

IV. Provider business mailing address

3102 ROCKY LN
ONTARIO CA
91761-5071
US

V. Phone/Fax

Practice location:
  • Phone: 760-252-3502
  • Fax:
Mailing address:
  • Phone: 909-702-0856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number70343
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number70343
License Number StateCA

VIII. Authorized Official

Name: DR. ANH LE
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 909-702-0856