Provider Demographics
NPI:1649590613
Name:RITE AID PHARMACY
Entity Type:Organization
Organization Name:RITE AID PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUGRAJ
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:JOHL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:530-823-8125
Mailing Address - Street 1:963 SOUTHBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8040
Mailing Address - Country:US
Mailing Address - Phone:530-823-8125
Mailing Address - Fax:530-823-8179
Practice Address - Street 1:2805 BELL RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2539
Practice Address - Country:US
Practice Address - Phone:530-823-8125
Practice Address - Fax:530-823-8179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA4266603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42055OtherRPH