Provider Demographics
NPI:1194138750
Name:RITE AID PHARMACY
Entity type:Organization
Organization Name:RITE AID PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANGER
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-235-6363
Mailing Address - Street 1:3521 CORUNNA RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-3267
Mailing Address - Country:US
Mailing Address - Phone:810-235-6363
Mailing Address - Fax:
Practice Address - Street 1:3521 CORUNNA RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-3267
Practice Address - Country:US
Practice Address - Phone:810-235-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040683183500000X
OH03331105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty