Healthcare Provider Details

I. General information

NPI: 1376954354
Provider Name (Legal Business Name): RITE AID PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 LINDEN AVE
DAYTON OH
45410-3027
US

IV. Provider business mailing address

2916 LINDEN AVE
DAYTON OH
45410-3027
US

V. Phone/Fax

Practice location:
  • Phone: 937-256-3111
  • Fax:
Mailing address:
  • Phone: 937-256-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number03223261-2
License Number StateOH

VIII. Authorized Official

Name: JOHARI EVANS
Title or Position: PHARMACY DISTRICT MANAGER
Credential:
Phone: 937-694-5522