Healthcare Provider Details

I. General information

NPI: 1396944872
Provider Name (Legal Business Name): RALEYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 FLOYD AVE
MODESTO CA
95355-9604
US

IV. Provider business mailing address

500 WEST CAPITOL AVE.
WEST SACRAMENTO CA
95605-2696
US

V. Phone/Fax

Practice location:
  • Phone: 209-551-6030
  • Fax:
Mailing address:
  • Phone: 916-373-6394
  • Fax: 916-372-6226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY53520
License Number StateCA

VIII. Authorized Official

Name: HELEN S SINGMASTER
Title or Position: SECRETARY
Credential:
Phone: 916-373-6394