# ROGUE VALLEY MANOR

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ROGUE VALLEY MANOR PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265572150
- **Authorized official:** FRED MILLAN RPH (DIRECTOR OF PHARMACY)
- **Authorized official phone:** (541) 857-7361

## Contact information

- **Practice address:** 1250 MIRA MAR AVE, MEDFORD, OR 97504-5520
- **Practice address phone:** (541) 857-7361
- **Practice address fax:** (541) 857-7362
- **Mailing address:** 1250 MIRA MAR AVE, MEDFORD, OR 97504-5520
- **Mailing address phone:** (541) 857-7361
- **Mailing address fax:** (541) 857-7362

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RP0000882 | OR | Yes |
| 3336I0012X | Institutional Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 02/08/2007
- **Last updated:** 04/11/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2078260 | PK | — |
| 05 | — | 385250 | — | OR |