MEDICARE: RICKERT ENTERPRISES

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	PHY47495	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0509072	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891730602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICKERT ENTERPRISES

Provider Business Mailing Address
First Line	:	211 S MAIN ST
Second Line	:
City	:	ALTURAS
State	:	CA
Zip	:	96101-4052
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 S MAIN ST
Second Line	:
City	:	ALTURAS
State	:	CA
Zip	:	96101-4052
Country	:	US
Telephone Number	:	530-233-2524
Fax Number	:	530-233-2703

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL RICKERT
Credential	:	RPH
Telephone Number	:	530-233-2524

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	08/22/2020

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Directions to “RICKERT ENTERPRISES ” Practice Location

Language	Start Address	Practice Location

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