Healthcare Provider Details

I. General information

NPI: 1003926767
Provider Name (Legal Business Name): RALEYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8852 LAKEWOOD DR
WINDSOR CA
95492-9595
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 707-838-4319
  • 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 NumberPHY53522
License Number StateCA

VIII. Authorized Official

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