Healthcare Provider Details

I. General information

NPI: 1609196351
Provider Name (Legal Business Name): RIDLEYS FAMILY MARKETS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 HIGHWAY 30
BUHL ID
83316-5054
US

IV. Provider business mailing address

621 WASHINGTON ST S
TWIN FALLS ID
83301-5519
US

V. Phone/Fax

Practice location:
  • Phone: 208-543-9944
  • Fax: 208-543-2338
Mailing address:
  • Phone: 208-423-4248
  • Fax: 208-423-5767

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 Number2412RP
License Number StateID

VIII. Authorized Official

Name: TODD WISE
Title or Position: PHARMACY COORDINATOR
Credential: DOC OF PHARMACY
Phone: 801-358-3365