MEDICARE: RALPHS GROCERY COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	PHY45148	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0558734	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1376568972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALPHS GROCERY COMPANY

Provider Business Mailing Address
First Line	:	1100 W ARTESIA BLVD
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90220-5108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4250 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2004
Country	:	US
Telephone Number	:	562-423-3551
Fax Number	:	562-423-3541

Authorized Official
Title or Position	:	PHARMACY LICENSING MANAGER
Name	:	KARLA LANGWORTHY
Credential	:
Telephone Number	:	513-698-1878

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	04/26/2012

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Directions to “RALPHS GROCERY COMPANY ” Practice Location

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