Provider Demographics
NPI:1700871217
Name:RALEY PRESCRIPTION PHARMACY
Entity Type:Organization
Organization Name:RALEY PRESCRIPTION PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:918-266-2283
Mailing Address - Street 1:19320 E ADMIRAL PL
Mailing Address - Street 2:P.O. BOX 1740
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-3207
Mailing Address - Country:US
Mailing Address - Phone:918-266-2283
Mailing Address - Fax:918-266-4746
Practice Address - Street 1:19320 E ADMIRAL PL
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-3207
Practice Address - Country:US
Practice Address - Phone:918-266-2283
Practice Address - Fax:918-266-4746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty