NPIMap

Organization Active NPI

Ridley's Family Markets, Inc

Doing business as Ridley's Pharmacy #7156

  • Community/Retail Pharmacy
  • Pocatello, ID
National Provider Identifier
1184050148
Registry record updated Sep 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
22546RP Issued in ID
Legal business name
RIDLEY'S FAMILY MARKETS, INC
Doing business as
Ridley's Pharmacy #7156
Practice address
1000 Pocatello Creek Rd
Pocatello, ID 83201-2926
Phone
(208) 233-4051
Fax
(208) 233-2888
NPI assigned
Sep 23, 2013
Last updated
Sep 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cathi Ketterling, PHARM, D
Title
Pharmacy Coordinator
Phone
(208) 324-4633

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 22546RP ID Primary

Addresses

Primary practice location

1000 Pocatello Creek Rd
Pocatello, ID 83201-2926

Mailing address

621 Washington St S
Twin Falls, ID 83301-5519
Phone (208) 233-4051

Other identifiers 1

IdentifierTypeStateIssuer
22546RPOtherIDSTATE LIC

Other names 1

  • Ridley's Pharmacy #7156 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2076333Ridley's Pharmacy #71561000 Pocatello Creek Rd, Pocatello, ID 83201Certificate of waiverApr 15, 2028

National Provider Directory

National Provider Directory
Tax ID family
Ridleys Family Markets Inc36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Locations

280 S Idaho St
Wendell, ID 83355
Phone (208) 536-5761

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379894400000",
    "number": "1184050148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 WASHINGTON ST S",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015519",
            "telephone_number": "208-233-4051",
            "fax_number": "208-233-2888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 POCATELLO CREEK RD",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012926",
            "telephone_number": "208-233-4051",
            "fax_number": "208-233-2888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDLEY'S FAMILY MARKETS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-23",
        "last_updated": "2013-09-23",
        "status": "A",
        "authorized_official_last_name": "KETTERLING",
        "authorized_official_first_name": "CATHI",
        "authorized_official_title_or_position": "PHARMACY COORDINATOR",
        "authorized_official_telephone_number": "208-324-4633",
        "authorized_official_credential": "PHARM, D"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "22546RP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LIC",
            "identifier": "22546RP",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ridley's Pharmacy #7156",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.