Healthcare Provider Details

I. General information

NPI: 1215243605
Provider Name (Legal Business Name): RITA AID PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 N SANDERSON AVE
HEMET CA
92545-3614
US

IV. Provider business mailing address

3800 W DEVONSHIRE AVE APRT 114 D
HEMET CA
92545-2361
US

V. Phone/Fax

Practice location:
  • Phone: 951-658-3418
  • Fax:
Mailing address:
  • Phone: 805-720-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRPH63772
License Number StateCA

VIII. Authorized Official

Name: MOHAMED GAMAL KHALAF
Title or Position: PHARMACIST
Credential:
Phone: 805-720-7455