=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669762399
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITE AID PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2011
-----------------------------------------------------
Last Update Date | 04/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10805 CENTENNIAL DR
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30022-4924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-740-1028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10805 CENTENNIAL DR
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30022-4924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-740-1028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FLOATER PHARMACIST
-----------------------------------------------------
Name | MR. JOSEPH JOHN LASKY
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 770-740-1028
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH017803
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------