Provider Demographics
NPI:1023186921
Name:RALPHS GROCERY COMPANY
Entity Type:Organization
Organization Name:RALPHS GROCERY COMPANY
Other - Org Name:FOOD4LESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY ECOMMERCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-387-7113
Mailing Address - Street 1:3250 E FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3250 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7479
Practice Address - Country:US
Practice Address - Phone:702-433-8375
Practice Address - Fax:702-433-8975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NVPH018153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2907028OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NV100500451Medicaid
3953350111Medicare NSC
39964Medicare PIN