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General NPI Number Information
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NPI Number | 1962860015
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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 | 02/03/2016
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Last Update Date | 02/03/2016
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Provider Practice Location Address
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Address Line | 408 GRAND ST
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City | NEW YORK
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State | NY
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Zip | 10002-4702
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Country | US
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Telephone | 646-510-0643
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Fax |
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Provider Business Mailing Address
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Address Line | 4413 30TH AVE
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City | ASTORIA
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State | NY
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Zip | 11103-2151
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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 | PHARMACY DISTRICT MANAGER
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Name | DINA JAZRAWI
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Credential |
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Telephone | 212-529-2181
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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 | 058713
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License Number State | NY
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