MEDICARE: RITEAID PHARMACY

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	251S00000X	Community/Behavioral Health Agency	19971	MD

General Provider Information

NPI Number	:	1760899058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITEAID PHARMACY

Provider Business Mailing Address
First Line	:	12 NOAH CT
Second Line	:
City	:	WOODSTOCK
State	:	MD
Zip	:	21163-1146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5741 SILVER HILL RD
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-1102
Country	:	US
Telephone Number	:	301-736-0904
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	DR. ANDREW OBUOKOR ANYAN
Credential	:
Telephone Number	:	410-207-9002

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	07/17/2014

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