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General NPI Number Information
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NPI Number | 1124319264
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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 | 04/24/2011
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Last Update Date | 04/24/2011
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Provider Practice Location Address
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Address Line | 2960 MAIN ST
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City | SUSANVILLE
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State | CA
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Zip | 96130-4730
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Country | US
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Telephone | 530-257-0603
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Fax | 530-257-2737
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Provider Business Mailing Address
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Address Line | 1450 PAIUTE LN
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City | SUSANVILLE
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State | CA
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Zip | 96130-3585
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Country | US
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Telephone | 530-310-1717
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. FRANK EDWIN MAURINO
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Credential | RPH
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Telephone | 530-310-1717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 35354
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 35354
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License Number State | CA
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