NPIMap

Organization Active NPI

Raley's Arizona LLC

Doing business as Food City United Drug 060

  • Community/Retail Pharmacy
  • Nogales, AZ
National Provider Identifier
1639198724
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
Doing business as
Food City United Drug 060
Practice address
450 N Grand Court PLZ
Nogales, AZ 85621-2748
Phone
(520) 287-3984
NPI assigned
Jul 19, 2006
Last updated
Apr 29, 2022By the provider in NPPES
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 4444 AZ
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

450 N Grand Court PLZ
Nogales, AZ 85621-2748

Mailing address

PO Box 488
Chandler, AZ 85244-0488
Phone (480) 895-5372

Other identifiers 2

IdentifierTypeStateIssuer
0354427OtherAZNCPDP
110648MedicaidAZ

Other names 1

  • Food City United Drug 060 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

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651190400000",
    "number": "1639198724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 488",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852440488",
            "telephone_number": "480-895-5372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 N GRAND COURT PLZ",
            "city": "NOGALES",
            "state": "AZ",
            "postal_code": "856212748",
            "telephone_number": "520-287-3984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RALEY'S ARIZONA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "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": "4444",
            "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",
            "identifier": "0354427",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110648",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Food City United Drug 060",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nogales, 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.