=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811241110
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITE AID PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2012
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5845 E LOS ANGELES AVE
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93063-4256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-522-2029
-----------------------------------------------------
Fax | 805-522-3218
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5845 E LOS ANGELES AVE
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93063-4256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-522-2029
-----------------------------------------------------
Fax | 805-522-3218
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. SAMIR BASSILI DEIBO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-203-7021
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 87411
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 8
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------