MEDICARE: RALPHS GROCERY CO

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	RPH 58038	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447644000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALPHS GROCERY CO

Provider Business Mailing Address
First Line	:	102 S IRENA AVE APT 1
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3426
Country	:	US
Telephone Number	:	310-378-5214
Fax Number	:	310-378-7247

Provider Business Practice Location Address
First Line	:	102 S IRENA AVE APT 1
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3426
Country	:	US
Telephone Number	:	310-378-5214
Fax Number	:	310-378-7247

Authorized Official
Title or Position	:	PHARMACIST/PHARMACYMANAGER
Name	:	DR. JANET M BAUTISTA
Credential	:	DOCTOR OF PHARMACY
Telephone Number	:	310-378-5214

Provider Enumeration Date	:	03/22/2015
Last Update Date	:	03/22/2015

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Directions to “RALPHS GROCERY CO ” Practice Location

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