Healthcare Provider Details

I. General information

NPI: 1023322906
Provider Name (Legal Business Name): RIDLEY'S FAMILY MARKETS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 STEPTOE CIR
ELY NV
89301-2692
US

IV. Provider business mailing address

6 STEPTOE CIR
ELY NV
89301-2692
US

V. Phone/Fax

Practice location:
  • Phone: 775-289-3420
  • Fax:
Mailing address:
  • Phone: 208-324-4633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH02113
License Number StateNV

VIII. Authorized Official

Name: DR. CATHI B KETTERLING
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 208-324-4633