Healthcare Provider Details

I. General information

NPI: 1184092769
Provider Name (Legal Business Name): RITE AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2015
Last Update Date: 09/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11609 S SAGINAW ST
GRAND BLANC MI
48439-1354
US

IV. Provider business mailing address

11609 S SAGINAW ST
GRAND BLANC MI
48439-1354
US

V. Phone/Fax

Practice location:
  • Phone: 810-694-4983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5302040182
License Number StateMI

VIII. Authorized Official

Name: CHRISTOPHER GJEROVSKI
Title or Position: PHARMACIST
Credential: PHARM.D
Phone: 586-242-3389