Healthcare Provider Details

I. General information

NPI: 1023186921
Provider Name (Legal Business Name): RALPHS GROCERY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 E FLAMINGO RD
LAS VEGAS NV
89121-7479
US

IV. Provider business mailing address

3250 E FLAMINGO RD
LAS VEGAS NV
89121-7479
US

V. Phone/Fax

Practice location:
  • Phone: 702-433-8375
  • Fax: 702-433-8975
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH01815
License Number StateNV

VIII. Authorized Official

Name: ANGELA TRUSTER
Title or Position: PHARMACY ECOMMERCE MANAGER
Credential:
Phone: 513-387-7113