Provider Demographics
NPI:1659785111
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:GAETANO
Authorized Official - Middle Name:
Authorized Official - Last Name:FASCIANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-654-6689
Mailing Address - Street 1:801 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643-2770
Mailing Address - Country:US
Mailing Address - Phone:570-654-6689
Mailing Address - Fax:
Practice Address - Street 1:801 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:WEST PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643-2770
Practice Address - Country:US
Practice Address - Phone:570-654-6689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4456593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy