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General NPI Number Information
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NPI Number | 1790113538
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Entity Type | Organization
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Legal Business Name | RIVER VALLEY COMPOUNDING PHARMACY
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Dates
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Enumeration Date | 10/14/2013
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 615 N PLAZA CT SUITE A
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City | VAN BUREN
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State | AR
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Zip | 72956-2600
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Country | US
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Telephone | 479-420-4428
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Fax |
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Provider Business Mailing Address
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Address Line | 615 NORTH PLAZA DRIVE SUITE A
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City | VAN BUREN
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State | AR
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Zip | 72956
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Country | US
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Telephone | 479-420-4428
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. LAUREN BROOKE DENTON
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Credential | PHARM.D.
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Telephone | 870-678-3004
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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 |
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License Number State |
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Taxonomy #2
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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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