Healthcare Provider Details

I. General information

NPI: 1598179079
Provider Name (Legal Business Name): RITE AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25996 GRATIOT AVENUE
ROSEVILLE MI
48066
US

IV. Provider business mailing address

25996 GRATIOT AVENUE
ROSEVILLE MI
48066
US

V. Phone/Fax

Practice location:
  • Phone: 586-774-1070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302039468
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL WODECKI
Title or Position: PHARMACIST
Credential:
Phone: 586-713-8676