Healthcare Provider Details

I. General information

NPI: 1417335803
Provider Name (Legal Business Name): RITE AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 W 26TH ST
ERIE PA
16508-1803
US

IV. Provider business mailing address

1844 W GRANDVIEW BLVD APT 102
ERIE PA
16509-1077
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-4012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449137
License Number StatePA

VIII. Authorized Official

Name: JAYE MENOHER
Title or Position: PHARMACIST
Credential:
Phone: 814-323-9333