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General NPI Number Information
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NPI Number | 1003942913
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Entity Type | Organization
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Legal Business Name | RIDLEY'S FAMILY MARKETS, INC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 210 MAIN ST. SOUTH
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City | KIMBERLY
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State | ID
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Zip | 83341-0443
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Country | US
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Telephone | 208-423-4248
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Fax | 208-423-5767
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Provider Business Mailing Address
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Address Line | 621 WASHINGTON ST. SOUTH
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City | TWIN FALLS
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State | ID
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Zip | 83301-5519
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Country | US
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Telephone | 208-324-4633
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Fax | 208-324-1190
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CATHI KETTERLING
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Credential | PHARMD
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Telephone | 208-324-4633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1730 CP
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1730CP
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License Number State | ID
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