1649590613 NPI number — RITE AID PHARMACY

Table of content: (NPI 1649590613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649590613 NPI number — RITE AID PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RITE AID PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649590613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
963 SOUTHBRIDGE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95648-8040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-823-8125
Provider Business Mailing Address Fax Number:
530-823-8179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2805 BELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-2539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-823-8125
Provider Business Practice Location Address Fax Number:
530-823-8179
Provider Enumeration Date:
06/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JOHL
Authorized Official First Name:
JUGRAJ
Authorized Official Middle Name:
SINGH
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
530-823-8125

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHA426660 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42055 . This is a "RPH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com