Provider Demographics
NPI:1508309832
Name:RITE AID
Entity Type:Organization
Organization Name:RITE AID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KALUGENDO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:615-717-5132
Mailing Address - Street 1:785 S COLUMBIA RIVER HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-2928
Mailing Address - Country:US
Mailing Address - Phone:503-397-6787
Mailing Address - Fax:
Practice Address - Street 1:785 S COLUMBIA RIVER HWY
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-2928
Practice Address - Country:US
Practice Address - Phone:503-397-6787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00157403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy