Organization
RIDGE PHARMACY INC
Active
Other names
RIDGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD TIERNEY RPH (OWNER)
(847) 251-0315
Entity
Organization
Contact information
Practice address
1919 LAKE AVE, WILMETTE, IL 60091-1422
(847) 251-0315
(847) 251-0377
Mailing address
1919 LAKE AVE, WILMETTE, IL 60091-1422
(847) 251-0315
(847) 251-0377
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054003535
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1428514
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/31/2006
Last updated
12/01/2011
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