Organization
RALEY'S ARIZONA LLC
Active
Organization
RALEY'S ARIZONA LLC
Active
Other names
BASHAS UNITED DRUG, Bashas United Drug 116
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE MCKINLEY (DIRECTOR OF PHARMACY)
(480) 895-5372
Entity
Organization
Contact information
Practice address
3269 MARICOPA AVE, STE 120, LAKE HAVASU CITY, AZ 86406-8593
(928) 854-9551
(928) 854-9553
Mailing address
PO BOX 488, DEPT 3, CHANDLER, AZ 85244-0488
(480) 895-9350
(480) 895-5371
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Y003678
AZ
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0327432
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
739063
—
AZ
Enumeration date
08/20/2006
Last updated
04/29/2022
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