Healthcare Provider Details

I. General information

NPI: 1750759536
Provider Name (Legal Business Name): PATRICK KYLE RAIDY PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3490 S POWER RD
GILBERT AZ
85234-0043
US

IV. Provider business mailing address

435 S ELLSWORTH RD
MESA AZ
85208-2305
US

V. Phone/Fax

Practice location:
  • Phone: 480-550-3185
  • Fax: 480-697-4517
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS021496
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: