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NPI Code Detail

MEDICARE: ROSS VALLEY COMPOUNDING PHARMACY, INC.

MEDICARE: ROSS VALLEY COMPOUNDING PHARMACY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0004XCompounding PharmacyPHY52077CA

General Provider Information

NPI Number : 1881099018
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROSS VALLEY COMPOUNDING PHARMACY, INC.
Provider Business Mailing Address
First Line : 1525 FRANCISCO BLVD E
Second Line : STE 1
City : SAN RAFAEL
State : CA
Zip : 94901-5539
Country : US
Telephone Number : 415-924-2480
Fax Number : 415-924-1015
Provider Business Practice Location Address
First Line : 1525 FRANCISCO BLVD E
Second Line : STE 1
City : SAN RAFAEL
State : CA
Zip : 94901-5539
Country : US
Telephone Number : 415-924-2480
Fax Number : 415-924-1015
Authorized Official
Title or Position : PRESIDENT
Name : DR. PAUL W LOFHOLM
Credential : PHARMD
Telephone Number : 415-924-2480
Provider Enumeration Date : 10/30/2014
Last Update Date : 10/30/2014

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Directions to “ROSS VALLEY COMPOUNDING PHARMACY, INC. ” Practice Location

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