Provider Demographics
NPI:1558719278
Name:RITEAID
Entity Type:Organization
Organization Name:RITEAID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:251-360-9482
Mailing Address - Street 1:8748 LAREDO ST
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-2130
Mailing Address - Country:US
Mailing Address - Phone:850-259-0704
Mailing Address - Fax:
Practice Address - Street 1:506 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-2626
Practice Address - Country:US
Practice Address - Phone:251-368-8131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19156305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service