Healthcare Provider Details

I. General information

NPI: 1841599008
Provider Name (Legal Business Name): THRIFTY RITE AID CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2011
Last Update Date: 03/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N WILSON WAY
STOCKTON CA
95205-4218
US

IV. Provider business mailing address

5260 HILDRETH LN
STOCKTON CA
95212-2320
US

V. Phone/Fax

Practice location:
  • Phone: 209-948-0950
  • Fax:
Mailing address:
  • Phone: 209-948-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number43978
License Number StateCA

VIII. Authorized Official

Name: MICHAEL CASTAGNO
Title or Position: PHARMACIST
Credential:
Phone: 209-948-0950