Provider Demographics
NPI:1114095015
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 1:1100 W ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-5108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2255 N LAS VEGAS BLVD
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-5840
Practice Address - Country:US
Practice Address - Phone:702-642-1111
Practice Address - Fax:702-642-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NVPHY015923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002802580Medicaid
2904399OtherNCPDP PROVIDER IDENTIFICATION NUMBER
39958Medicare PIN
3953350011Medicare NSC