Provider Demographics
NPI:1447644000
Name:RALPHS GROCERY CO
Entity type:Organization
Organization Name:RALPHS GROCERY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/PHARMACYMANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF PHARMACY
Authorized Official - Phone:310-378-5214
Mailing Address - Street 1:102 S IRENA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3426
Mailing Address - Country:US
Mailing Address - Phone:310-378-5214
Mailing Address - Fax:310-378-7247
Practice Address - Street 1:102 S IRENA AVE APT 1
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3426
Practice Address - Country:US
Practice Address - Phone:310-378-5214
Practice Address - Fax:310-378-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-22
Last Update Date:2015-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 580383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720003320Medicaid
CA1720003320Medicaid
CA1720003320Medicare PIN
CA1720003320Medicare Oscar/Certification
CA1720003320Medicare NSC