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General NPI Number Information
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NPI Number | 1699170829
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Entity Type | Organization
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Legal Business Name | RITE AID PHARMACY
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 6164 BOLLINGER RD
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City | SAN JOSE
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State | CA
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Zip | 95129-3068
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Country | US
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Telephone | 408-253-5257
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Fax | 408-253-3704
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Provider Business Mailing Address
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Address Line | 6164 BOLLINGER RD
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City | SAN JOSE
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State | CA
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Zip | 95129-3068
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Country | US
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Telephone | 408-253-5257
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Fax | 408-253-3704
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Authorized Official
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Title or Position | PHARMACIST
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Name | SI YUN WANG
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Credential |
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Telephone | 415-812-7094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 71804
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License Number State | CA
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