Healthcare Provider Details

I. General information

NPI: 1891730602
Provider Name (Legal Business Name): RICKERT ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S MAIN ST
ALTURAS CA
96101-4052
US

IV. Provider business mailing address

211 S MAIN ST
ALTURAS CA
96101-4052
US

V. Phone/Fax

Practice location:
  • Phone: 530-233-2524
  • Fax: 530-233-2703
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY47495
License Number StateCA

VIII. Authorized Official

Name: DANIEL RICKERT
Title or Position: OWNER
Credential: RPH
Phone: 530-233-2524