=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710358304
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIDLEYS FAMILY MARKETS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2015
-----------------------------------------------------
Last Update Date | 09/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1041 GRASS VALLEY RD
-----------------------------------------------------
City | WINNEMUCCA
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89445-4208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-623-2548
-----------------------------------------------------
Fax | 775-623-5806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 621 WASHINGTON ST S
-----------------------------------------------------
City | TWIN FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83301-5519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-324-4633
-----------------------------------------------------
Fax | 208-324-1190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY COORDINATOR
-----------------------------------------------------
Name | TODD WISE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-358-3365
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH00394
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------