=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316350655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITE AID PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2014
-----------------------------------------------------
Last Update Date | 06/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 FRIENDLY DRIVE
-----------------------------------------------------
City | DUNCANNON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-834-6303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 157 5 FRIENDLY DRIVE
-----------------------------------------------------
City | DUNCANNON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-834-6303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STAFF PHARMACIST
-----------------------------------------------------
Name | RENNIE BILLOW
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 717-834-6303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | RP448041
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------