NPIMap

Organization Active NPI

Ridley's Family Markets, Inc

Doing business as Ridley's Pharmacy #1136

  • Community/Retail Pharmacy
  • Wellington, CO
National Provider Identifier
1831619089
Registry record updated Jul 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PDO1680000144 Issued in CO
Legal business name
RIDLEY'S FAMILY MARKETS, INC
Doing business as
Ridley's Pharmacy #1136
Practice address
7670 5TH St
Wellington, CO 80549-1500
Phone
(970) 568-3197
Fax
(970) 825-7041
NPI assigned
Jun 20, 2017
Last updated
Jul 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2021

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 Co Director
Phone
(208) 320-2073

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PDO1680000144 CO Primary

Addresses

Primary practice location

7670 5TH St
Wellington, CO 80549-1500

Mailing address

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

Other names 1

  • Ridley's Pharmacy #1136 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200513001247 CO Part B Supplier - Pharmacy 6709170111 Practice locations: Wellington, CO
O20200706002299 CO Part B Supplier - Mass Immunization (Roster Biller Only) 6709170111 Practice locations: Wellington, CO

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
06D2174635Ridley's Pharmacy #11367670 5TH Street, Wellington, CO 80549Certificate of waiverNov 4, 2027

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

7670 5th St
Wellington, CO 80549
Phone (970) 568-7282

NPI Registry JSON

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626307200000",
    "number": "1831619089",
    "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": "7670 5TH ST",
            "city": "WELLINGTON",
            "state": "CO",
            "postal_code": "805491500",
            "telephone_number": "970-568-3197",
            "fax_number": "970-825-7041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDLEY'S FAMILY MARKETS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-20",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "KETTERLING",
        "authorized_official_first_name": "CATHI",
        "authorized_official_middle_name": "BAILY",
        "authorized_official_title_or_position": "PHARMACY CO DIRECTOR",
        "authorized_official_telephone_number": "208-320-2073",
        "authorized_official_credential": "PHARM. D"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CO",
            "license": "PDO1680000144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ridley's Pharmacy #1136",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wellington, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; 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.