Healthcare Provider Details

I. General information

NPI: 1093123697
Provider Name (Legal Business Name): RITE AID PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2014
Last Update Date: 07/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 E 12 MILE RD
WARREN MI
48092-5642
US

IV. Provider business mailing address

2003 E 12 MILE RD
WARREN MI
48092-5642
US

V. Phone/Fax

Practice location:
  • Phone: 586-751-3600
  • Fax: 586-751-1257
Mailing address:
  • Phone: 586-751-3600
  • Fax: 586-751-1257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5302033297
License Number StateMI

VIII. Authorized Official

Name: MR. JOHN BOZEVICH
Title or Position: PHARMACY DISTRICT MANAGER
Credential:
Phone: 248-399-4022