Provider Demographics
NPI:1730299496
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:916-372-6226
Practice Address - Street 1:311 S LOWER SACRAMENTO RD
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3322
Practice Address - Country:US
Practice Address - Phone:209-369-7403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY535403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0578495OtherNABP
CA1730299496Medicaid
P00288273Medicare PIN
0578495OtherNABP
0216380038Medicare NSC