Provider Demographics
NPI:1932653573
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:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBIK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:518-368-9801
Mailing Address - Street 1:3D FULHAM RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-6323
Mailing Address - Country:US
Mailing Address - Phone:518-368-9801
Mailing Address - Fax:
Practice Address - Street 1:2 N PARK ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12816-1105
Practice Address - Country:US
Practice Address - Phone:518-677-3822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20 0582403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy