Healthcare Provider Details

I. General information

NPI: 1134678386
Provider Name (Legal Business Name): RITE AID PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 JOHNSON AVE
SAN LUIS OBISPO CA
93401-3306
US

IV. Provider business mailing address

1251 JOHNSON AVE
SAN LUIS OBISPO CA
93401-3306
US

V. Phone/Fax

Practice location:
  • Phone: 805-545-0655
  • Fax:
Mailing address:
  • Phone: 805-545-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number68458
License Number StateCA

VIII. Authorized Official

Name: RAMI HADDADIN
Title or Position: PHARMACIST
Credential:
Phone: 312-714-5324