Provider Demographics
NPI:1457662959
Name:RITE AID
Entity Type:Organization
Organization Name:RITE AID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH MGR
Authorized Official - Prefix:
Authorized Official - First Name:TENZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTTOROFF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-756-7531
Mailing Address - Street 1:2040 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-2328
Mailing Address - Country:US
Mailing Address - Phone:541-756-7531
Mailing Address - Fax:541-756-4136
Practice Address - Street 1:2040 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2328
Practice Address - Country:US
Practice Address - Phone:541-756-7531
Practice Address - Fax:541-756-4136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9818302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization