MEDICARE: RIDGWAY DRUG

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	2-05978	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1707174	OTHER	KS	NCPDP NUMBER

General Provider Information

NPI Number	:	1487657938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDGWAY DRUG

Provider Business Mailing Address
First Line	:	PO BOX 407
Second Line	:
City	:	OSBORNE
State	:	KS
Zip	:	67473-0407
Country	:	US
Telephone Number	:	785-346-2136
Fax Number	:	785-346-5898

Provider Business Practice Location Address
First Line	:	103 W MAIN ST
Second Line	:
City	:	OSBORNE
State	:	KS
Zip	:	67473-2402
Country	:	US
Telephone Number	:	785-346-2136
Fax Number	:	785-346-5898

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES RIDGWAY
Credential	:
Telephone Number	:	785-346-2136

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	08/22/2020

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