Healthcare Provider Details

I. General information

NPI: 1932219607
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

3301 SOUTHERN BLVD SE
RIO RANCHO NM
87124-2085
US

IV. Provider business mailing address

3301 SOUTHERN BLVD SE
RIO RANCHO NM
87124-2085
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-0895
  • Fax: 505-892-3238
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH00002360
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