Healthcare Provider Details

I. General information

NPI: 1689087710
Provider Name (Legal Business Name): RITE AID CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 JACKSON AVE
ESCALON CA
95320-2051
US

IV. Provider business mailing address

2135 JACKSON AVE
ESCALON CA
95320-2051
US

V. Phone/Fax

Practice location:
  • Phone: 209-838-3524
  • Fax: 209-838-6855
Mailing address:
  • Phone: 209-838-3524
  • Fax: 209-838-6855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCA66852
License Number StateCA

VIII. Authorized Official

Name: MRS. MICHELLE TENERELLI
Title or Position: CLINICAL MANAGER
Credential:
Phone: 916-852-1736