Healthcare Provider Details

I. General information

NPI: 1003822461
Provider Name (Legal Business Name): RALEY'S ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3923 N FLOWING WELLS RD
TUCSON AZ
85705-2451
US

IV. Provider business mailing address

3923 N FLOWING WELLS RD
TUCSON AZ
85705-2451
US

V. Phone/Fax

Practice location:
  • Phone: 520-887-4422
  • Fax: 520-292-6152
Mailing address:
  • Phone: 520-887-4422
  • Fax: 520-292-6152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY002629
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MIKE MCKINLEY
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 480-895-5372