Provider Demographics
NPI:1700116050
Name:RIDLEY'S FAMILY MARKETS, INC
Entity type:Organization
Organization Name:RIDLEY'S FAMILY MARKETS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHI
Authorized Official - Middle Name:B
Authorized Official - Last Name:KETTERLING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:208-324-4633
Mailing Address - Street 1:621 WASHINGTON ST. SOUTH
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5519
Mailing Address - Country:US
Mailing Address - Phone:208-324-4633
Mailing Address - Fax:208-324-1190
Practice Address - Street 1:1689 GREAT BASIN HWY
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-3154
Practice Address - Country:US
Practice Address - Phone:775-289-2671
Practice Address - Fax:775-289-6950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH004533336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1700116050Medicaid
NVPH00453OtherNV. STATE RETAIL PHARMACY LISC.- # PH00453
NVPH00453OtherNV. STATE RETAIL PHARMACY LISC.- # PH00453
NV0721340017Medicare NSC