Provider Demographics
NPI:1497124135
Name:RITE AID PHARMACY
Entity Type:Organization
Organization Name:RITE AID PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DISTRICT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:GOWDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-247-4108
Mailing Address - Street 1:20718 SW SISTER LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-8155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7440 N DENVER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5630
Practice Address - Country:US
Practice Address - Phone:503-286-5680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH00148763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy