Provider Demographics
NPI:1487657938
Name:RIDGWAY DRUG
Entity Type:Organization
Organization Name:RIDGWAY DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDGWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-346-2136
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:OSBORNE
Mailing Address - State:KS
Mailing Address - Zip Code:67473-0407
Mailing Address - Country:US
Mailing Address - Phone:785-346-2136
Mailing Address - Fax:785-346-5898
Practice Address - Street 1:103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OSBORNE
Practice Address - State:KS
Practice Address - Zip Code:67473-2402
Practice Address - Country:US
Practice Address - Phone:785-346-2136
Practice Address - Fax:785-346-5898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-05978333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1707174OtherNCPDP NUMBER
KS1707174OtherNCPDP NUMBER