MEDICARE: RITE AID PHARMACY, INC.

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	305S00000X	Point of Service		AZ

General Provider Information

NPI Number	:	1992114623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RITE AID PHARMACY, INC.

Provider Business Mailing Address
First Line	:	7509 N 35TH AVE STE 2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-7480
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7509 N 35TH AVE STE 2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-7480
Country	:	US
Telephone Number	:	602-376-5939
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ALBERT LANCHIAN
Credential	:
Telephone Number	:	602-376-5939

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	08/06/2014

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