Healthcare Provider Details

I. General information

NPI: 1407396344
Provider Name (Legal Business Name): RITE AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2017
Last Update Date: 02/25/2017
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

1050 N WILSON WAY
STOCKTON CA
95205-4218
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number76308
License Number StateCA

VIII. Authorized Official

Name: DARSHAN UDANI
Title or Position: PHARMACIST
Credential: PHARM D
Phone: 209-948-0590