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General NPI Number Information
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NPI Number | 1073895918
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Entity Type | Organization
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Legal Business Name | RIDLEYS FAMILY MARKETS INC
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 275 E 300 N
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City | MORGAN
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State | UT
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Zip | 84050-9520
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Country | US
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Telephone | 801-829-6271
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Fax | 801-829-6278
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Provider Business Mailing Address
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Address Line | 621 WASHINGTON ST S
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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 | PHARMACY COORDINATOR
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Name | TODD WISE
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Credential |
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Telephone | 801-358-3365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 8087837-1
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License Number State | UT
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