NPIMap

Organization Active NPI

Raley'S Arizona LLC

  • Community/Retail Pharmacy
  • Lake Havasu City, AZ
National Provider Identifier
1083729008
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
RALEY'S ARIZONA LLC
Practice address
3269 Maricopa Ave
Ste 120
Lake Havasu City, AZ 86406-8593
Phone
(928) 854-9551
Fax
(928) 854-9553
NPI assigned
Aug 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mike McKinley
Title
Director of Pharmacy
Phone
(480) 895-5372

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Y003678 AZ
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

3269 Maricopa Ave
Ste 120
Lake Havasu City, AZ 86406-8593

Mailing address

PO Box 488
Dept 3
Chandler, AZ 85244-0488
Phone (480) 895-9350

Other identifiers 2

IdentifierTypeStateIssuer
0327432OtherNCPDP PROVIDER IDENTIFICATION NUMBER
739063MedicaidAZ

Other names 2

  • BASHAS UNITED DRUG Doing business as
  • Bashas United Drug 116 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230308001395 AZ Part B Supplier - Pharmacy 0840663050 37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Queen Creek, AZ; Scottsdale, AZ; Sedona, AZ; Sierra Vista, AZ; Sun City West, AZ; Sun Lakes, AZ; Surprise, AZ; Tempe, AZ…

Other NPIs on the same Medicare enrollment 37

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 37

National Provider Directory

National Provider Directory
Tax ID family
Bashas39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Locations

3269 Maricopa Ave
Ste 120
Lake Havasu City, AZ 86406
Phone (928) 854-9551

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651190400000",
    "number": "1083729008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 488",
            "address_2": "DEPT 3",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852440488",
            "telephone_number": "480-895-9350",
            "fax_number": "480-895-5371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3269 MARICOPA AVE",
            "address_2": "STE 120",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864068593",
            "telephone_number": "928-854-9551",
            "fax_number": "928-854-9553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RALEY'S ARIZONA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A",
        "authorized_official_last_name": "MCKINLEY",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "480-895-5372"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "Y003678",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0327432",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "739063",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BASHAS UNITED DRUG",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bashas United Drug 116",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.