Provider Demographics
NPI:1215039607
Name:RALEYS
Entity Type:Organization
Organization Name:RALEYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SINGMASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-373-6394
Mailing Address - Street 1:500 WEST CAPITOL AVE.
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-2696
Mailing Address - Country:US
Mailing Address - Phone:916-373-6394
Mailing Address - Fax:
Practice Address - Street 1:1040 EMERALD BAY ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6200
Practice Address - Country:US
Practice Address - Phone:530-541-5410
Practice Address - Fax:530-541-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY534813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215039607Medicaid
0562985OtherNCPDP
0562985OtherNCPDP
PH00288273Medicare PIN
CA1215039607Medicaid