Healthcare Provider Details

I. General information

NPI: 1598076002
Provider Name (Legal Business Name): RITE AID PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9910 FRANKFORD AVE
PHILADELPHIA PA
19114
US

IV. Provider business mailing address

9910 FRANKFORD AVE
PHILADELPHIA PA
19114-1900
US

V. Phone/Fax

Practice location:
  • Phone: 215-824-2700
  • Fax:
Mailing address:
  • Phone: 215-824-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRP438544
License Number StatePA

VIII. Authorized Official

Name: DR. TIMOTHY K WALTON
Title or Position: PHARMACIST
Credential:
Phone: 215-673-7575