Provider Demographics
NPI:1790796324
Name:RIO LINDA LEADER DRUGS
Entity Type:Organization
Organization Name:RIO LINDA LEADER DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCT REV MGR
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RITCHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-991-1701
Mailing Address - Street 1:402 M ST
Mailing Address - Street 2:
Mailing Address - City:RIO LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95673-2217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:402 M ST
Practice Address - Street 2:
Practice Address - City:RIO LINDA
Practice Address - State:CA
Practice Address - Zip Code:95673-2217
Practice Address - Country:US
Practice Address - Phone:916-991-1701
Practice Address - Fax:916-991-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY428863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0541828OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0541828OtherOTHER ID NUMBER
CAPHA428860Medicaid
CA6019013Medicaid