Healthcare Provider Details

I. General information

NPI: 1538487699
Provider Name (Legal Business Name): RITE AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 W REDONDO BEACH BLVD
GARDENA CA
90247-3411
US

IV. Provider business mailing address

1208 W REDONDO BEACH BLVD
GARDENA CA
90247-3411
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-4768
  • Fax: 310-323-4693
Mailing address:
  • Phone: 310-323-4768
  • Fax: 310-323-4693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number42442
License Number StateCA

VIII. Authorized Official

Name: MICHELLE TENERELLI
Title or Position: TERRITORY MGR
Credential:
Phone: 916-631-7591