Healthcare Provider Details

I. General information

NPI: 1659786341
Provider Name (Legal Business Name): RITE AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2014
Last Update Date: 06/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S 700 E
SALT LAKE CITY UT
84102-2106
US

IV. Provider business mailing address

1865 E LOGAN AVE
SALT LAKE CITY UT
84108-2631
US

V. Phone/Fax

Practice location:
  • Phone: 801-521-4140
  • Fax:
Mailing address:
  • Phone: 301-707-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0007741
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7960198-1701
License Number StateUT

VIII. Authorized Official

Name: NATHAN WILSON
Title or Position: PHARMACIST
Credential: PHARMD.
Phone: 801-521-4140