Provider Demographics
NPI:1396944872
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 1:3020 FLOYD AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-9604
Practice Address - Country:US
Practice Address - Phone:209-551-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY535203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396944872Medicaid
5627712OtherNCPDP
AV870KMedicare PIN
CA1396944872Medicaid
P00288273Medicare PIN