Healthcare Provider Details

I. General information

NPI: 1083027114
Provider Name (Legal Business Name): RITE AID PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 W LEHIGH AVE PHARMACY DEPT
PHILADELPHIA PA
19133-3425
US

IV. Provider business mailing address

260 W LEHIGH AVE PHARMACY DEPT
PHILADELPHIA PA
19133-3425
US

V. Phone/Fax

Practice location:
  • Phone: 215-425-3784
  • Fax: 215-425-0740
Mailing address:
  • Phone: 215-425-3784
  • Fax: 215-425-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRP443662
License Number StatePA

VIII. Authorized Official

Name: DR. VU NGUYEN
Title or Position: PHARMACIST
Credential: PHARM.D
Phone: 267-516-3155