Provider Demographics
NPI:1861627895
Name:RITEAID
Entity Type:Organization
Organization Name:RITEAID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-975-8676
Mailing Address - Street 1:265 PASCACK RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-4809
Mailing Address - Country:US
Mailing Address - Phone:201-665-5289
Mailing Address - Fax:201-664-5298
Practice Address - Street 1:265 PASCACK RD
Practice Address - Street 2:
Practice Address - City:TOWNSHIP OF WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07676-4809
Practice Address - Country:US
Practice Address - Phone:201-665-5289
Practice Address - Fax:201-664-5298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02375600302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02375600OtherPHARMACIST