Provider Demographics
NPI:1467855759
Name:RITE AID
Entity type:Organization
Organization Name:RITE AID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECORD FIELD CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:RECORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-412-4575
Mailing Address - Street 1:8819 10TH DR SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11700 MUKILTEO SPEEDWAY STE 500
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5435
Practice Address - Country:US
Practice Address - Phone:425-514-0620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60477558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty