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NPI Code Detail

MEDICARE: RALEYS OF NEW MEXICO INC

MEDICARE: RALEYS OF NEW MEXICO INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacyPH00002389NM
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13210591OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1720198492
Entity Type Code : Organization
Provider Name (Legal Business Name) : RALEYS OF NEW MEXICO INC
Provider Business Mailing Address
First Line : 7800 ENCHANTED HILLS BLVD NE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87144-8623
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7800 ENCHANTED HILLS BLVD NE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87144-8623
Country : US
Telephone Number : 505-771-8411
Fax Number : 505-771-9255
Authorized Official
Title or Position : VP PHARMACY AND HLI
Name : FLINT PENDERGRAFT
Credential : PHARMD
Telephone Number : 916-373-6146
Provider Enumeration Date : 08/30/2006
Last Update Date : 09/11/2025

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Directions to “RALEYS OF NEW MEXICO INC ” Practice Location

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