Provider Demographics
NPI:1609944438
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 1:5420 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5420 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5614
Practice Address - Country:US
Practice Address - Phone:323-460-4204
Practice Address - Fax:323-460-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY465503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5600893OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA465500Medicaid
PHY46550Medicare PIN
5600893OtherNCPDP PROVIDER IDENTIFICATION NUMBER