MEDICARE: RITE AID 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	3336C0003X	Community/Retail Pharmacy	RP448894	PA

General Provider Information

NPI Number	:	1891194080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITE AID PHARMACY

Provider Business Mailing Address
First Line	:	8130 ROOSEVELT BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2911
Country	:	US
Telephone Number	:	215-331-0160
Fax Number	:

Provider Business Practice Location Address
First Line	:	8130 ROOSEVELT BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2911
Country	:	US
Telephone Number	:	215-331-0160
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. NABIL H DHARSI
Credential	:	PHARMD
Telephone Number	:	717-514-6026

Provider Enumeration Date	:	08/14/2014
Last Update Date	:	08/14/2014

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