NPIMap

Organization Active NPI

Ridley's Family Markets, Inc

Doing business as Ridley's Pharmacy #1167

  • Pharmacy
  • Highland, UT
National Provider Identifier
1245676741
Registry record updated May 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
8526422-1703 Issued in UT
Legal business name
RIDLEY'S FAMILY MARKETS, INC
Doing business as
Ridley's Pharmacy #1167
Practice address
5353 W 11000 N
Highland, UT 84003-9403
Phone
(801) 756-8353
Fax
(801) 756-3525
NPI assigned
May 11, 2013
Last updated
May 11, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2013

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

Authorized official

Name
Cathi Baily Ketterling, PHARM. D
Title
Pharmacy Coordinator
Phone
(208) 320-2073

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 8526422-1703 UT Primary

Addresses

Primary practice location

5353 W 11000 N
Highland, UT 84003-9403

Mailing address

621 Washington St S
Twin Falls, ID 83301-5519
Phone (208) 324-4633

Other identifiers 1

IdentifierTypeStateIssuer
8526422-1703OtherUTPHARMACY LICENSE

Other names 1

  • Ridley's Pharmacy #1167 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161005002762 UT Part B Supplier - Mass Immunization (Roster Biller Only) 6709170111 7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tremonton, UT; Ogden, UT; Morgan, UT; Highland, UT; Midway, UT; Eagle Mountain, UT

Other NPIs on the same Medicare enrollment 4

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

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
46D2087978Ridley's Pharmacy #11675353 West 11000 North, Highland, UT 84003Certificate of waiverDec 8, 2026

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

NPI Registry JSON

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

{
    "created_epoch": "1368230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368230400000",
    "number": "1245676741",
    "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": "208-324-4633",
            "fax_number": "208-324-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5353 W 11000 N",
            "city": "HIGHLAND",
            "state": "UT",
            "postal_code": "840039403",
            "telephone_number": "801-756-8353",
            "fax_number": "801-756-3525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDLEY'S FAMILY MARKETS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-11",
        "last_updated": "2013-05-11",
        "status": "A",
        "authorized_official_last_name": "KETTERLING",
        "authorized_official_first_name": "CATHI",
        "authorized_official_middle_name": "BAILY",
        "authorized_official_title_or_position": "PHARMACY COORDINATOR",
        "authorized_official_telephone_number": "208-320-2073",
        "authorized_official_credential": "PHARM. D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "UT",
            "license": "8526422-1703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "8526422-1703",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ridley's Pharmacy #1167",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Highland, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.