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Organization
ROCK VALLEY COMPOUNDING PHARMACY LLC
Active
Organization
ROCK VALLEY COMPOUNDING PHARMACY LLC
Active
Other names
Rock Valley Compounding Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN M LEHAN PHARMD (PHARMACIST IN CHARGE)
(779) 423-0542
Entity
Organization
Contact information
Practice address
811 S PERRYVILLE RD UNIT 109, ROCKFORD, IL 61108-4323
(779) 423-0542
(779) 545-2277
Mailing address
811 S PERRYVILLE RD UNIT 109, ROCKFORD, IL 61108-4323
(779) 423-0542
(779) 545-2277
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
054018235
IL
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135285
PK
—
05
—
362674647002
—
IL
Enumeration date
05/09/2012
Last updated
08/04/2022
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