Provider Demographics
NPI:1083029607
Name:RITE AID
Entity Type:Organization
Organization Name:RITE AID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KOFI
Authorized Official - Middle Name:O
Authorized Official - Last Name:ABANQUAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-474-5447
Mailing Address - Street 1:4641 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19139
Mailing Address - Country:US
Mailing Address - Phone:215-474-5447
Mailing Address - Fax:215-474-5429
Practice Address - Street 1:4641 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19139-4612
Practice Address - Country:US
Practice Address - Phone:215-474-5447
Practice Address - Fax:215-474-5429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP10034023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy