Provider Demographics
NPI:1558386151
Name:RALPHS GROCERY COMPANY
Entity Type:Organization
Organization Name:RALPHS GROCERY COMPANY
Other - Org Name:RALPHS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CENTRAL OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:MINEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-387-7074
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 1:591 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-7691
Practice Address - Country:US
Practice Address - Phone:805-526-8555
Practice Address - Fax:805-526-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY450253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA450250Medicaid
0557592OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PHY45025Medicare PIN
CAPHA450250Medicaid