=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669925509
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITE AID PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2016
-----------------------------------------------------
Last Update Date | 07/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 E LITTLE CREEK RD
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23518-3824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-588-8694
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5315 HENNEMAN DR
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23513-2401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY DISTRICT MANAGER
-----------------------------------------------------
Name | MR. SATHISH ARCOT JAISHANKERV
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-247-2027
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0202215144
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------