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General NPI Number Information
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NPI Number | 1679609077
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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 | 02/27/2007
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 1295 PARKWAY DR
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City | BLACKFOOT
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State | ID
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Zip | 83221-1683
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Country | US
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Telephone | 208-785-1311
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Fax | 208-785-7071
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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 | OWNER
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Name | TODD WISE
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Credential | DOC OF PHARM
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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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 | 1809RP
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License Number State | ID
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