Provider Demographics
NPI:1437565249
Name:RITE AID PHARMACY
Entity Type:Organization
Organization Name:RITE AID PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT MANAGER ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ULLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-321-1472
Mailing Address - Street 1:16860 WALNUT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-5750
Mailing Address - Country:US
Mailing Address - Phone:440-610-2799
Mailing Address - Fax:
Practice Address - Street 1:16207 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3784
Practice Address - Country:US
Practice Address - Phone:216-521-8826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233148-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03233148-2OtherPHARMACY STATE LICENSE