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General NPI Number Information
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NPI Number | 1457662959
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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 | 06/30/2010
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 2040 BROADWAY ST
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City | NORTH BEND
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State | OR
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Zip | 97459-2328
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Country | US
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Telephone | 541-756-7531
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Fax | 541-756-4136
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Provider Business Mailing Address
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Address Line | 2040 BROADWAY ST
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City | NORTH BEND
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State | OR
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Zip | 97459-2328
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Country | US
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Telephone | 541-756-7531
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Fax | 541-756-4136
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Authorized Official
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Title or Position | RPH MGR
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Name | TENZIN BOTTOROFF
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Credential | RPH
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Telephone | 541-756-7531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 9818
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License Number State | OR
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