Healthcare Provider Details

I. General information

NPI: 1548249568
Provider Name (Legal Business Name): RIPON DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W MAIN ST
RIPON CA
95366-2426
US

IV. Provider business mailing address

410 W MAIN ST
RIPON CA
95366-2426
US

V. Phone/Fax

Practice location:
  • Phone: 209-599-4271
  • Fax: 209-599-3537
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHA22163
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS LARSON
Title or Position: OWNER
Credential: PHARM D
Phone: 209-599-4271