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General NPI Number Information
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NPI Number | 1922411875
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Entity Type | Organization
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Legal Business Name | RITE AID
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 575 M STREET
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City | CRESCENT CITY
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State | CA
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Zip | 95531
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Country | US
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Telephone | 530-242-6487
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Fax |
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Provider Business Mailing Address
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Address Line | 462 FERDINAND AVE P.O. BOX 338
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City | EL GRANADA
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State | CA
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Zip | 94018
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | VAHAN NISHKIAN
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Credential |
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Telephone | 530-242-6487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21708
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License Number State | CA
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