=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194072496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITE AID PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2012
-----------------------------------------------------
Last Update Date | 08/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 52 ROCKINGHAM RD
-----------------------------------------------------
City | DERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03038-4126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-432-2505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 52 ROCKINGHAM RD
-----------------------------------------------------
City | DERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03038-4126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-432-2505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STAFF PHARMACIST
-----------------------------------------------------
Name | DR. DIVYESH ASHOKBHAI BHAGAT
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 978-983-4535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 3850
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------