Healthcare Provider Details

I. General information

NPI: 1356456370
Provider Name (Legal Business Name): RALEY'S ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3275 N SWAN RD
TUCSON AZ
85712-1228
US

IV. Provider business mailing address

3275 N SWAN RD
TUCSON AZ
85712-1228
US

V. Phone/Fax

Practice location:
  • Phone: 520-323-5821
  • Fax: 520-323-5823
Mailing address:
  • Phone: 520-323-5821
  • Fax: 520-323-5823

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 NumberY003676
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