Healthcare Provider Details

I. General information

NPI: 1104370899
Provider Name (Legal Business Name): RITE AID PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 MINERAL SPRING AVE
NORTH PROVIDENCE RI
02904-4003
US

IV. Provider business mailing address

96 GANO ST APT #4
PROVIDENCE RI
02906-3848
US

V. Phone/Fax

Practice location:
  • Phone: 401-353-3113
  • Fax:
Mailing address:
  • Phone: 401-218-5356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRPH05626
License Number StateRI

VIII. Authorized Official

Name: DIANE KURISCAK
Title or Position: PHARMACY DISTRICT MANAGER
Credential: PHARMD
Phone: 774-218-5495