Healthcare Provider Details

I. General information

NPI: 1508303108
Provider Name (Legal Business Name): RITE AID PHARMACY#4913
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2017
Last Update Date: 01/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 SAVANNAH RD
LEWES DE
19958-1462
US

IV. Provider business mailing address

444 SAVANNAH RD
LEWES DE
19958-1462
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-6243
  • Fax:
Mailing address:
  • Phone: 302-645-6243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberA3-0000671
License Number StateDE

VIII. Authorized Official

Name: MARIAN M MORCOUS
Title or Position: PHARMACIST
Credential:
Phone: 302-645-6243