Healthcare Provider Details

I. General information

NPI: 1386933026
Provider Name (Legal Business Name): RITE AIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3680 MAIN ST
STRATFORD CT
06614-4102
US

IV. Provider business mailing address

130 W RIVER ST
MILFORD CT
06460-3422
US

V. Phone/Fax

Practice location:
  • Phone: 203-377-8065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7713
License Number StateCT

VIII. Authorized Official

Name: STEPHEN PAINE
Title or Position: PHARMACIST
Credential:
Phone: 203-783-0788