Healthcare Provider Details

I. General information

NPI: 1144467366
Provider Name (Legal Business Name): RICKERT INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43597 HWY 299E
FALL RIVER MILLS CA
96028
US

IV. Provider business mailing address

PO BOX 399
FALL RIVER MILLS CA
96028-0399
US

V. Phone/Fax

Practice location:
  • Phone: 530-336-6555
  • Fax: 530-336-6001
Mailing address:
  • Phone: 530-336-6555
  • Fax: 530-336-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number49181
License Number StateCA

VIII. Authorized Official

Name: DANIEL C RICKERT
Title or Position: CEO
Credential: PHARM D
Phone: 530-336-6555