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General NPI Number Information
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NPI Number | 1811939309
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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 | 06/11/2006
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 1831 KIOWA AVE STE 100
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-2461
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Country | US
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Telephone | 928-855-2494
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Fax | 928-855-4794
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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 | 480-895-9350
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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 | 4311
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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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