Provider Demographics
NPI:1023322906
Name:RIDLEY'S FAMILY MARKETS, INC
Entity type:Organization
Organization Name:RIDLEY'S FAMILY MARKETS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHI
Authorized Official - Middle Name:B
Authorized Official - Last Name:KETTERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-324-4633
Mailing Address - Street 1:6 STEPTOE CIR
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-2692
Mailing Address - Country:US
Mailing Address - Phone:208-324-4633
Mailing Address - Fax:
Practice Address - Street 1:6 STEPTOE CIR
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-2692
Practice Address - Country:US
Practice Address - Phone:775-289-3420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH021133336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1023322906Medicaid
NVPH02113OtherNEVADA STATE PHARMACY LICENSE
NVFR2119786OtherDEA LICENSE
NV0721340010Medicare NSC