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General NPI Number Information
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NPI Number | 1376802462
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Entity Type | Organization
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Legal Business Name | ROCK VALLEY COMPOUNDING PHARMACY LLC
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 811 S PERRYVILLE RD UNIT 109
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City | ROCKFORD
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State | IL
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Zip | 61108-4323
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Country | US
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Telephone | 779-423-0542
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Fax | 779-545-2277
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Provider Business Mailing Address
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Address Line | 811 S PERRYVILLE RD UNIT 109
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City | ROCKFORD
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State | IL
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Zip | 61108-4323
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Country | US
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Telephone | 779-423-0542
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Fax | 779-545-2277
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | JONATHAN M LEHAN
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Credential | PHARMD
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Telephone | 779-423-0542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054018235
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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