Provider Demographics
NPI:1750717054
Name:RITE AID
Entity type:Organization
Organization Name:RITE AID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARI
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBET-OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-246-0346
Mailing Address - Street 1:2390 SW VERMONT ST
Mailing Address - Street 2:APT 39
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1977
Mailing Address - Country:US
Mailing Address - Phone:971-221-3934
Mailing Address - Fax:
Practice Address - Street 1:12575 SW WALKER RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1306
Practice Address - Country:US
Practice Address - Phone:503-646-2423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH 0013774261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center