NPIMap

Organization Active NPI

Raleys

  • Community/Retail Pharmacy
  • Chico, CA
National Provider Identifier
1609986363
Registry record updated Jun 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY53494 Issued in CA
Legal business name
RALEYS
Practice address
211 West East Ave
Chico, CA 95926-7202
Phone
(530) 899-3790
NPI assigned
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2015

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

Authorized official

Name
Flint Pendergraft, PHARMD
Title
VP Pharmacy and Hli
Phone
(916) 373-6146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHY53494 CA Primary

Addresses

Primary practice location

211 West East Ave
Chico, CA 95926-7202

Mailing address

500 West Capitol Ave.
West Sacramento, CA 95605-2696
Phone (916) 373-6146

Other identifiers 2

IdentifierTypeStateIssuer
1609986363MedicaidCA
0509135OtherNABP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040831000246 CA Part B Supplier - Mass Immunization (Roster Biller Only) 2365417722 This NPI is an additional NPI on the enrollment
Practice locations: Sacramento, CA; Petaluma, CA; S Lake Tahoe, CA; Rohnert Park, CA; Rohnert, CA; Redding, CA; Red Bluff, CA; Pleasanton, CA…
O20100930018753 CA DME Supplier - Pharmacy 2365417722 Practice locations: Chico, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Raleys Pharmacy #245211 W East Ave, Chico, CA 95926-7202(530) 899-3790 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Automatic Ext Defibrillator (AEDS) and/or Supplies|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Infrared Heating Pads Systems and/or Supplies… Does not accept assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Raleys 24852 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

211 W East Ave
Chico, CA 95926
Phone (530) 899-3790

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433116800000",
    "number": "1609986363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 WEST CAPITOL AVE.",
            "city": "WEST SACRAMENTO",
            "state": "CA",
            "postal_code": "956052696",
            "telephone_number": "916-373-6146",
            "fax_number": "916-372-6226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 WEST EAST AVE",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959267202",
            "telephone_number": "530-899-3790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RALEYS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2015-06-01",
        "status": "A",
        "authorized_official_last_name": "PENDERGRAFT",
        "authorized_official_first_name": "FLINT",
        "authorized_official_title_or_position": "VP PHARMACY AND HLI",
        "authorized_official_telephone_number": "916-373-6146",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY53494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609986363",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "0509135",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chico, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.