# RIDGE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** RIDGE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912019852
- **Authorized official:** DONALD TIERNEY RPH (OWNER)
- **Authorized official phone:** (847) 251-0315

## Contact information

- **Practice address:** 1919 LAKE AVE, WILMETTE, IL 60091-1422
- **Practice address phone:** (847) 251-0315
- **Practice address fax:** (847) 251-0377
- **Mailing address:** 1919 LAKE AVE, WILMETTE, IL 60091-1422
- **Mailing address phone:** (847) 251-0315
- **Mailing address fax:** (847) 251-0377

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054003535 | IL | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 12/01/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1428514 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |