=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487812095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITE AID PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2008
-----------------------------------------------------
Last Update Date | 05/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6164 BOLLINGER RD
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95129-3068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-253-5257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6244 TRACEL DR
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95129-4761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | ENGSON CHANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 408-255-9849
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 45250
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------