Healthcare Provider Details

I. General information

NPI: 1881063899
Provider Name (Legal Business Name): RITE AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 E FLORENCE AVE
LOS ANGELES CA
90001-2536
US

IV. Provider business mailing address

1534 E FLORENCE AVE
LOS ANGELES CA
90001-2536
US

V. Phone/Fax

Practice location:
  • Phone: 323-587-6336
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number73171
License Number StateCA

VIII. Authorized Official

Name: MR. BASSEM HENEIN
Title or Position: PHARMACY DISTRICT MANAGER
Credential:
Phone: 310-325-2813