Organization
RIDLEYS FAMILY MARKETS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD WISE (PHARMACY COORDINATOR)
(801) 358-3365
Entity
Organization
Contact information
Practice address
341 EAST PINE ST, PINEDALE, WY 82941
(307) 367-4451
(307) 367-6651
Mailing address
621 WASHINGTON ST S, TWIN FALLS, ID 83301-5519
(208) 324-4633
(208) 324-1190
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
R10037
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891909198
—
WY
01
—
2111624
PK
—
Enumeration date
05/09/2007
Last updated
05/02/2018
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