Healthcare Provider Details

I. General information

NPI: 1558735761
Provider Name (Legal Business Name): RITE AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2015
Last Update Date: 11/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 BIDDLE AVE
WYANDOTTE MI
48192-3907
US

IV. Provider business mailing address

1998 BIDDLE AVE
WYANDOTTE MI
48192-3907
US

V. Phone/Fax

Practice location:
  • Phone: 734-285-4100
  • Fax:
Mailing address:
  • Phone: 734-285-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302041092
License Number StateMI

VIII. Authorized Official

Name: RUTH GRAHAM
Title or Position: PHARMACY DISTRICT MANAGER
Credential:
Phone: 419-756-2819