1205904000 NPI number — RALPHS GROCERY COMPANY

Table of content: (NPI 1205904000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205904000 NPI number — RALPHS GROCERY COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RALPHS GROCERY COMPANY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205904000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 W ARTESIA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMPTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90220-5108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 HACIENDA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92081-6604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-630-5121
Provider Business Practice Location Address Fax Number:
760-630-5186
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUPP
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MERCHANDISER
Authorized Official Telephone Number:
310-884-4722

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PHY46704 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHY46704 . This is a "MEDICARE MASS IMMUNIZER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5613232 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: PHA467040 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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