MEDICARE: RIDLEY'S 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
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1386467009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDLEY'S FAMILY MARKETS, INC

Provider Business Mailing Address
First Line	:	621 WASHINGTON ST S
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-6293
Country	:	US
Telephone Number	:	801-358-3365
Fax Number	:	385-331-5000

Provider Business Practice Location Address
First Line	:	568 SPRING VALLEY CT
Second Line	:
City	:	SPRING CREEK
State	:	NV
Zip	:	89815-6821
Country	:	US
Telephone Number	:	775-735-9248
Fax Number	:	385-331-5000

Authorized Official
Title or Position	:	DIRECTOR OF PHAMRACY
Name	:	TODD ROBERT WISE
Credential	:
Telephone Number	:	801-358-3365

Provider Enumeration Date	:	11/01/2024
Last Update Date	:	11/08/2024

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