=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598299174
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITE AID PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2017
-----------------------------------------------------
Last Update Date | 04/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 BROAD ST
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02907-1481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-331-9550
-----------------------------------------------------
Fax | 401-272-7634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 BROAD ST
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02907-1481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-331-9550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | COLLETTE CHINWE ONYEJEKWE
-----------------------------------------------------
Credential | PHARMD, RPH
-----------------------------------------------------
Telephone | 401-999-0630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | RPH05701
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------