NPIMap

Organization Active NPI

Ridleys Family Markets Inc

Doing business as Ridleys Pharmacy #7153

  • Community/Retail Pharmacy
  • Blackfoot, ID
National Provider Identifier
1679609077
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
1809RP Issued in ID
Legal business name
RIDLEYS FAMILY MARKETS INC
Doing business as
Ridleys Pharmacy #7153
Practice address
1295 Parkway Dr
Blackfoot, ID 83221-1683
Phone
(208) 785-1311
Fax
(208) 785-7071
NPI assigned
Feb 27, 2007
Last updated
Jul 19, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2018

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

Authorized official

Name
Todd Wise, DOC OF PHARMNPI 1801310925
Title
Owner
Phone
(801) 358-3365

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 1809RP ID Primary

Addresses

Primary practice location

1295 Parkway Dr
Blackfoot, ID 83221-1683

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
2021879OtherPK
806730700MedicaidID
805772400MedicaidID

Other names 1

  • RIDLEYS PHARMACY #7153 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

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

1295 Parkway Dr
Blackfoot, ID 83221
Phone (208) 785-1311

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1679609077",
    "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": "1295 PARKWAY DR",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211683",
            "telephone_number": "208-785-1311",
            "fax_number": "208-785-7071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDLEYS FAMILY MARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "WISE",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-358-3365",
        "authorized_official_credential": "DOC OF PHARM"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "1809RP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2021879",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806730700",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805772400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RIDLEYS PHARMACY #7153",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blackfoot, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.