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General NPI Number Information
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NPI Number | 1356739122
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Entity Type | Organization
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Legal Business Name | RITE AID CORP
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 298 N MAIN ST
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City | ROMEO
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State | MI
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Zip | 48065
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Country | US
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Telephone | 586-255-6221
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Fax |
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Provider Business Mailing Address
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Address Line | 298 N MAIN ST
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City | ROMEO
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State | MI
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Zip | 48065
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. DANIEL LANE
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Credential | PHARM.D.
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Telephone | 989-635-2031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5302040276
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License Number State | MI
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