Healthcare Provider Details

I. General information

NPI: 1902916687
Provider Name (Legal Business Name): RALEYS OF NEW MEXICO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 JUAN TABO BLVD NE
ALBUQUERQUE NM
87112-1828
US

IV. Provider business mailing address

2910 JUAN TABO BLVD NE
ALBUQUERQUE NM
87112-1828
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-8600
  • Fax: 505-299-8609
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH00002743
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FLINT PENDERGRAFT
Title or Position: VP PHARMACY AND HLI
Credential: PHARMD
Phone: 916-373-6146