Provider Demographics
NPI:1568812105
Name:RITE AID PHARMACY
Entity Type:Organization
Organization Name:RITE AID PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:MINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-666-5610
Mailing Address - Street 1:177 OLD MILL RD
Mailing Address - Street 2:APT 5
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1990
Mailing Address - Country:US
Mailing Address - Phone:717-666-5610
Mailing Address - Fax:
Practice Address - Street 1:177 OLD MILL RD
Practice Address - Street 2:APT 5
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1990
Practice Address - Country:US
Practice Address - Phone:717-666-5610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100002282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty