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General NPI Number Information
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NPI Number | 1508309832
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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 | 11/18/2016
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 785 S COLUMBIA RIVER HWY
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City | SAINT HELENS
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State | OR
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Zip | 97051-2928
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Country | US
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Telephone | 503-397-6787
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Fax |
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Provider Business Mailing Address
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Address Line | 785 S COLUMBIA RIVER HWY
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City | SAINT HELENS
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State | OR
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Zip | 97051-2928
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Country | US
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Telephone | 503-397-6787
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | JESSE M KALUGENDO
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Credential | RPH
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Telephone | 615-717-5132
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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 | 0015740
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License Number State | OR
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