Provider Demographics
NPI:1043690035
Name:RITE AID PHARMACY
Entity Type:Organization
Organization Name:RITE AID PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ATEEQA
Authorized Official - Middle Name:SAMINA
Authorized Official - Last Name:KHALID
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:862-812-6778
Mailing Address - Street 1:480 N BEVERWYCK RD
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-2511
Mailing Address - Country:US
Mailing Address - Phone:973-334-4343
Mailing Address - Fax:
Practice Address - Street 1:480 N BEVERWYCK RD
Practice Address - Street 2:
Practice Address - City:LAKE HIAWATHA
Practice Address - State:NJ
Practice Address - Zip Code:07034-2511
Practice Address - Country:US
Practice Address - Phone:973-334-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03653500333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy