Healthcare Provider Details

I. General information

NPI: 1619420361
Provider Name (Legal Business Name): RITE AID CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4616 N BROAD ST
PHILADELPHIA PA
19140-1218
US

IV. Provider business mailing address

301 BYBERRY RD ST. E11
PHILADELPHIA PA
19116-1947
US

V. Phone/Fax

Practice location:
  • Phone: 215-329-4840
  • Fax:
Mailing address:
  • Phone: 267-608-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: DR. BORI DAVID FELDMAN
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 267-608-5000