Healthcare Provider Details

I. General information

NPI: 1508355405
Provider Name (Legal Business Name): RALEYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 STATE ROUTE 95A N
FERNLEY NV
89408
US

IV. Provider business mailing address

500 W CAPITOL AVE
WEST SACRAMENTO CA
95605-2696
US

V. Phone/Fax

Practice location:
  • Phone: 775-575-5065
  • Fax:
Mailing address:
  • Phone: 916-676-6687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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