Healthcare Provider Details

I. General information

NPI: 1790796324
Provider Name (Legal Business Name): RIO LINDA LEADER DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 M ST
RIO LINDA CA
95673-2217
US

IV. Provider business mailing address

402 M ST
RIO LINDA CA
95673-2217
US

V. Phone/Fax

Practice location:
  • Phone: 916-991-1701
  • Fax: 916-991-2389
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY42886
License Number StateCA

VIII. Authorized Official

Name: SAM RITCHIE
Title or Position: ACCT REV MGR
Credential:
Phone: 916-991-1701