Healthcare Provider Details

I. General information

NPI: 1124319264
Provider Name (Legal Business Name): RITE AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2011
Last Update Date: 04/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 MAIN ST
SUSANVILLE CA
96130-4730
US

IV. Provider business mailing address

1450 PAIUTE LN
SUSANVILLE CA
96130-3585
US

V. Phone/Fax

Practice location:
  • Phone: 530-257-0603
  • Fax: 530-257-2737
Mailing address:
  • Phone: 530-310-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35354
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number35354
License Number StateCA

VIII. Authorized Official

Name: MR. FRANK EDWIN MAURINO
Title or Position: PHARMACIST
Credential: RPH
Phone: 530-310-1717