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NPI Code Detail

MEDICARE: RIDLEYS FAMILY MARKETS INC

MEDICARE: RIDLEYS FAMILY MARKETS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyR10142WY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12150154OTHERPK

General Provider Information

NPI Number : 1144404641
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIDLEYS FAMILY MARKETS INC
Provider Business Mailing Address
First Line : 621 WASHINGTON ST S
Second Line :
City : TWIN FALLS
State : ID
Zip : 83301-5519
Country : US
Telephone Number : 208-324-4633
Fax Number : 208-324-1190
Provider Business Practice Location Address
First Line : 3112 E GRAND AVE
Second Line :
City : LARAMIE
State : WY
Zip : 82070-5141
Country : US
Telephone Number : 307-745-7246
Fax Number : 307-742-7392
Authorized Official
Title or Position : PHARMACY COORDINATOR
Name : TODD WISE
Credential :
Telephone Number : 801-358-3365
Provider Enumeration Date : 12/20/2007
Last Update Date : 11/29/2022

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Directions to “RIDLEYS FAMILY MARKETS INC ” Practice Location

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