Provider Demographics
NPI:1013164524
Name:RITE AID PHARMACY
Entity Type:Organization
Organization Name:RITE AID PHARMACY
Other - Org Name:BROOKS PHARMACY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:518-588-8336
Mailing Address - Street 1:1870 BEACON ST
Mailing Address - Street 2:APT. 6
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-1928
Mailing Address - Country:US
Mailing Address - Phone:617-269-5788
Mailing Address - Fax:
Practice Address - Street 1:710 E BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1504
Practice Address - Country:US
Practice Address - Phone:617-269-5788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty