Healthcare Provider Details

I. General information

NPI: 1023474426
Provider Name (Legal Business Name): RITE AID CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4013 PHELAN RD
PHELAN CA
92371-8912
US

IV. Provider business mailing address

4013 PHELAN RD
PHELAN CA
92371-8912
US

V. Phone/Fax

Practice location:
  • Phone: 760-868-3413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number73749
License Number StateCA

VIII. Authorized Official

Name: MICHAEL KHANH LUU
Title or Position: PHARMACIST
Credential:
Phone: 714-386-2652