Provider Demographics
NPI:1417360611
Name:RITEAID
Entity Type:Organization
Organization Name:RITEAID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWILL
Authorized Official - Middle Name:NABIL ANWAR
Authorized Official - Last Name:TADRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-688-5954
Mailing Address - Street 1:28343 WARE ST
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-4408
Mailing Address - Country:US
Mailing Address - Phone:510-688-5954
Mailing Address - Fax:951-943-9265
Practice Address - Street 1:1688 N PERRIS BLVD
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-4709
Practice Address - Country:US
Practice Address - Phone:951-943-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty