Provider Demographics
NPI:1265806350
Name:RITE AID PHARMACY
Entity type:Organization
Organization Name:RITE AID PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:IGHO
Authorized Official - Last Name:IDIARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-852-6133
Mailing Address - Street 1:116 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1709
Mailing Address - Country:US
Mailing Address - Phone:615-851-5700
Mailing Address - Fax:615-851-1611
Practice Address - Street 1:116 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1709
Practice Address - Country:US
Practice Address - Phone:615-851-5700
Practice Address - Fax:615-851-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000011542302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization