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General NPI Number Information
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NPI Number | 1386732279
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Entity Type | Organization
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Legal Business Name | RALEY'S ARIZONA LLC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 5555 N 7TH ST
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City | PHOENIX
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State | AZ
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Zip | 85014-2584
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Country | US
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Telephone | 602-277-6133
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Fax | 602-277-6136
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Provider Business Mailing Address
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Address Line | PO BOX 488
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City | CHANDLER
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State | AZ
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Zip | 85244-0488
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Country | US
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Telephone | 480-895-5349
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Fax | 480-895-5214
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MIKE MCKINLEY
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Credential |
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Telephone | 480-895-5372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | Y004012
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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