Provider Demographics
NPI:1356632384
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:SHIMROTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-424-7958
Mailing Address - Street 1:7709 233RD PL SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8763
Mailing Address - Country:US
Mailing Address - Phone:360-424-7958
Mailing Address - Fax:
Practice Address - Street 1:7709 233RD PL SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8763
Practice Address - Country:US
Practice Address - Phone:360-424-7958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00020743261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility