=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679972319
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITE AID PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2014
-----------------------------------------------------
Last Update Date | 08/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 HIGHMARKET ST
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29440-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-546-2568
-----------------------------------------------------
Fax | 843-546-1373
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 HIGHMARKET ST
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29440-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-546-2568
-----------------------------------------------------
Fax | 843-546-1373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STAFF PHARMACIST
-----------------------------------------------------
Name | DR. STEPHANIE VANCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 843-527-3888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 35741
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------