Provider Demographics
NPI:1164827739
Name:RITE AID
Entity Type:Organization
Organization Name:RITE AID
Other - Org Name:THRIFTY PAYLESS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHARMACY DISTRICT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:TENERELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-331-2710
Mailing Address - Street 1:975 E CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1045
Mailing Address - Country:US
Mailing Address - Phone:530-223-3930
Mailing Address - Fax:
Practice Address - Street 1:975 E CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1045
Practice Address - Country:US
Practice Address - Phone:530-223-3930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71461251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA183500000XOtherPHARMACIST