Provider Demographics
NPI:1376957738
Name:RITEAID PHARMACY
Entity Type:Organization
Organization Name:RITEAID PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENIDATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-259-2353
Mailing Address - Street 1:50 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3814
Mailing Address - Country:US
Mailing Address - Phone:203-258-7046
Mailing Address - Fax:
Practice Address - Street 1:50 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3814
Practice Address - Country:US
Practice Address - Phone:203-258-7046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0008672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty