Provider Demographics
NPI: | 1518376755 |
---|---|
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: | ARCHANA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SRIKANTH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 971-703-9852 |
Mailing Address - Street 1: | 5254 NW 153RD PL |
Mailing Address - Street 2: | |
Mailing Address - City: | PORTLAND |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97229-8954 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 503-308-4840 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2425 SE TV HWY |
Practice Address - Street 2: | |
Practice Address - City: | HILLSBORO |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97123-7977 |
Practice Address - Country: | US |
Practice Address - Phone: | 503-693-1009 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-08-12 |
Last Update Date: | 2014-08-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OR | RPH-0014097 | 3336C0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OR | RPH-0014097 | Other | PHARMACIST |