Healthcare Provider Details

I. General information

NPI: 1942606892
Provider Name (Legal Business Name): RITE AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 S COUNTY ROAD 489
LEWISTON MI
49756-8155
US

IV. Provider business mailing address

2855 S COUNTY ROAD 489
LEWISTON MI
49756-8155
US

V. Phone/Fax

Practice location:
  • Phone: 989-786-2239
  • Fax:
Mailing address:
  • Phone: 989-786-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number03234273
License Number StateOH

VIII. Authorized Official

Name: FRED THOMAS
Title or Position: PHARMACY DISTRICT MANAGER
Credential:
Phone: 989-705-1395