Healthcare Provider Details

I. General information

NPI: 1487657938
Provider Name (Legal Business Name): RIDGWAY DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W MAIN ST
OSBORNE KS
67473-2402
US

IV. Provider business mailing address

PO BOX 407
OSBORNE KS
67473-0407
US

V. Phone/Fax

Practice location:
  • Phone: 785-346-2136
  • Fax: 785-346-5898
Mailing address:
  • Phone: 785-346-2136
  • Fax: 785-346-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2-05978
License Number StateKS

VIII. Authorized Official

Name: JAMES RIDGWAY
Title or Position: OWNER
Credential:
Phone: 785-346-2136