Organization
RALEY'S ARIZONA LLC
Active
Other names
BASHAS, Bashas' United Drug 054
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE MCKINLEY (DIRECTOR OF PHARMACY)
(480) 895-5372
Entity
Organization
Contact information
Practice address
142 E HIGHWAY 260, PAYSON, AZ 85541
(928) 474-7039
(928) 474-3415
Mailing address
142 E HIGHWAY 260, PAYSON, AZ 85541
(928) 474-7039
(928) 474-3415
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Y004017
AZ
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0352409
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
880155
—
AZ
Enumeration date
10/17/2006
Last updated
04/20/2022
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