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Contact Information

RALEY'S ARIZONA LLC
142 E HIGHWAY 260
PAYSON, AZ85541
 Phone: 928-474-7039
 Fax: 928-474-3415
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for RALEY'S ARIZONA LLC

NPI Number 1972684181
LBN Legal business name RALEY'S ARIZONA LLC
Authorized official MIKE MCKINLEY - (DIRECTOR OF PHARMACY)
Entity Organization
Organization subpart 1 No
Enumeration date 10/17/2006
Last updated 04/20/2022 - About 4 years ago
Identifiers
AZ License # Y004017
AZ Medicaid 880155
Other 0352409 NCPDP PROVIDER IDENTIFICATION NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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