Provider Demographics
NPI:1003942913
Name:RIDLEY'S FAMILY MARKETS, INC
Entity Type:Organization
Organization Name:RIDLEY'S FAMILY MARKETS, INC
Other - Org Name:RIDLEY'S PHARMACY #8464
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:KETTERLING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
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 1:210 MAIN ST. SOUTH
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341-0443
Practice Address - Country:US
Practice Address - Phone:208-423-4248
Practice Address - Fax:208-423-5767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1730 CP332B00000X
ID1730CP3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806621200Medicaid
ID0721340016Medicare NSC