Ridleys Family Markets Inc
Organization Active NPI Community/Retail Pharmacy · Middleton, ID
NPI 1124155577 · NPPES record last updated Jul 19, 2018
Key facts
- NPI
- 1124155577
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 1494RP (ID)
- Legal business name
- RIDLEYS FAMILY MARKETS INC
- Practice address
- 430 E Main St
Middleton, ID 83644-3036 - Phone
- (208) 585-2900
- Fax
- (208) 585-3057
- NPI assigned
- Feb 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Todd Wise, DOC OF PHARMACY
- Title
- Pharmacy Coordinator
- Phone
- (801) 358-3365
Other NPIs on the same Medicare enrollment 13
Corporate family (same tax ID) 35
Practitioners 2
-
Lin-Foo Sam Lee, PHARM D
-
Abbey L. Mayes, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160817003238 | ID | Part B Supplier - Mass Immunization (Roster Biller Only) | 6709170111 |
13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wendell, ID; Blackfoot, ID; Weiser, ID; Star, ID; Rupert, ID; Pocatello, ID; Kuna, ID; Kimberly, ID… |
National Provider Directory
- Tax ID family
- Ridley'S Family Markets Inc
Locations
206 E Main St
Middleton, ID 83644
430 E Main St
Middleton, ID 83644
Phone (208) 585-2900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 1494RP | ID | Yes |
Addresses
Primary practice location
430 E Main St
Middleton, ID 83644-3036
Mailing address
621 Washington St S
Twin Falls, ID 83301-5519
Phone (208) 324-4633
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2021735 | Other | PK | |
| 805772400 | Medicaid | ID |
Other names
- RIDLEYS PHARMACY #8442
Other providers in Middleton, ID
- Relatyv Mobile Medical LLC
- Restad Chiropractic PLLC
- Julie Lee Restad
- Corina A Reyna
- Kenneth J Rhee
- Jessica Lyn Knecht Rose
- Karie Ann Rose
- Erin Michelle Salyer
- Allison Louise Sandoval
- Leah Schiffler
All providers in Middleton, ID · Community/Retail Pharmacy in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 19, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.