MEDICARE: RALEY'S ARIZONA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	Y003264	AZ
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0324777	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1275648297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALEY'S ARIZONA LLC

Provider Business Mailing Address
First Line	:	731 E UNION HILLS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-2900
Country	:	US
Telephone Number	:	602-652-9521
Fax Number	:	602-652-9523

Provider Business Practice Location Address
First Line	:	731 E UNION HILLS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-2900
Country	:	US
Telephone Number	:	602-652-9521
Fax Number	:	602-652-9523

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	MIKE MCKINLEY
Credential	:
Telephone Number	:	480-895-5372

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	04/18/2022

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Directions to “RALEY'S ARIZONA LLC ” Practice Location

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