Healthcare Provider Details

I. General information

NPI: 1558386151
Provider Name (Legal Business Name): RALPHS GROCERY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 COUNTRY CLUB DR
SIMI VALLEY CA
93065-7691
US

IV. Provider business mailing address

1100 W ARTESIA BLVD
COMPTON CA
90220-5108
US

V. Phone/Fax

Practice location:
  • Phone: 805-526-8555
  • Fax: 805-526-9580
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 TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY45025
License Number StateCA

VIII. Authorized Official

Name: MATT MINEER
Title or Position: CENTRAL OPERATIONS MANAGER
Credential:
Phone: 513-387-7074