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General NPI Number Information
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NPI Number | 1003135393
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Entity Type | Organization
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Legal Business Name | RITE AID
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 5128 E 2ND ST
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City | LONG BEACH
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State | CA
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Zip | 90803-5322
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Country | US
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Telephone | 562-433-0456
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Fax |
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Provider Business Mailing Address
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Address Line | 5128 E 2ND ST.
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City | LONG BEACH
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State | CA
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Zip | 90803
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Country | US
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Telephone | 562-433-0456
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Fax |
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Authorized Official
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Title or Position | MANAGER OF CLINICAL SERVICES
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Name | MRS. MICHELLE TENERELLI
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Credential |
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Telephone | 916-631-7591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 49649
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License Number State | CA
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