Provider Demographics
NPI:1528433174
Name:RITEAID PHARMACY
Entity type:Organization
Organization Name:RITEAID PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOYSAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:570-825-9481
Mailing Address - Street 1:15 W CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:MAHANOY CITY
Mailing Address - State:PA
Mailing Address - Zip Code:17948-2603
Mailing Address - Country:US
Mailing Address - Phone:570-590-8879
Mailing Address - Fax:
Practice Address - Street 1:15 W CENTRE ST
Practice Address - Street 2:
Practice Address - City:MAHANOY CITY
Practice Address - State:PA
Practice Address - Zip Code:17948-2603
Practice Address - Country:US
Practice Address - Phone:570-590-8879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP025668L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy