Provider Demographics
NPI:1891730602
Name:RICKERT ENTERPRISES
Entity Type:Organization
Organization Name:RICKERT ENTERPRISES
Other - Org Name:ALTURAS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKERT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:530-233-2524
Mailing Address - Street 1:211 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-4052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-4052
Practice Address - Country:US
Practice Address - Phone:530-233-2524
Practice Address - Fax:530-233-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY474953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0509072OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA366950Medicaid
CAPHA366950Medicaid