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General NPI Number Information
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NPI Number | 1376956607
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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 | 06/04/2014
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 3330 HAMILTON MILL RD
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City | BUFORD
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State | GA
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Zip | 30519-4005
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Country | US
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Telephone | 770-904-7188
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Fax |
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Provider Business Mailing Address
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Address Line | 1208 JOHN ADAMS DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-6616
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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 | AMANDA LEE SHELLY
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Credential |
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Telephone | 317-289-0729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 027304
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License Number State | GA
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