Provider Demographics
NPI:1295124410
Name:RITE AID
Entity type:Organization
Organization Name:RITE AID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DER MERWE
Authorized Official - Suffix:
Authorized Official - Credentials:B PHARM
Authorized Official - Phone:707-725-9314
Mailing Address - Street 1:725 S FORTUNA BLVD
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-3034
Mailing Address - Country:US
Mailing Address - Phone:707-725-9314
Mailing Address - Fax:
Practice Address - Street 1:725 S FORTUNA BLVD
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-3034
Practice Address - Country:US
Practice Address - Phone:707-725-9314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty