Organization
RALEY'S ARIZONA LLC
Active
Other names
BASHAS, Bashas' United Drug 155
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE MCKINLEY (DIRECTOR OF PHARMACY)
(480) 895-5372
Entity
Organization
Contact information
Practice address
9925 E BASELINE RD, MESA, AZ 85209-8325
(480) 357-2634
(480) 357-2423
Mailing address
9925 E BASELINE RD, MESA, AZ 85209-8325
(480) 357-2634
(480) 357-2423
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Y004020
AZ
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0352396
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
894750
—
AZ
Enumeration date
08/31/2006
Last updated
04/18/2022
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