Healthcare Provider Details

I. General information

NPI: 1629525795
Provider Name (Legal Business Name): RITE AID PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 DEKALB PIKE
NORTH WALES PA
19454
US

IV. Provider business mailing address

16 PEBBLE DR
HORSHAM PA
19044
US

V. Phone/Fax

Practice location:
  • Phone: 215-661-0141
  • Fax:
Mailing address:
  • Phone: 267-968-9784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP450920
License Number StatePA

VIII. Authorized Official

Name: KYU MIN LEE
Title or Position: PHARMACIST
Credential:
Phone: 267-968-9784