=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538487699
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITE AID
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2010
-----------------------------------------------------
Last Update Date | 05/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1208 W REDONDO BEACH BLVD
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90247-3411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-323-4768
-----------------------------------------------------
Fax | 310-323-4693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1208 W REDONDO BEACH BLVD
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90247-3411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-323-4768
-----------------------------------------------------
Fax | 310-323-4693
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TERRITORY MGR
-----------------------------------------------------
Name | MICHELLE TENERELLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-631-7591
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 42442
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------