=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346610078
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITE AID
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2015
-----------------------------------------------------
Last Update Date | 10/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 PEDRO WAY
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40391-8354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-745-7870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 PEDRO
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-745-7870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY DISTRICT MANAGER
-----------------------------------------------------
Name | MS. HESTER KREIN
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 859-389-9634
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 006532
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------