MEDICARE: RITE AID

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP1003968	PA
2	183500000X	Pharmacist	RP045848L	PA

General Provider Information

NPI Number	:	1588079909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITE AID

Provider Business Mailing Address
First Line	:	4960 WILLIAM FLYNN HWY
Second Line	:
City	:	ALLISON PARK
State	:	PA
Zip	:	15101-2354
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4960 WILLIAM FLYNN HWY
Second Line	:
City	:	ALLISON PARK
State	:	PA
Zip	:	15101-2354
Country	:	US
Telephone Number	:	724-443-5455
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MR. TIMOTHY GANNON
Credential	:
Telephone Number	:	724-443-5455

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	06/24/2014

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Directions to “RITE AID ” Practice Location

Language	Start Address	Practice Location

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