# RIVER VALLEY PHARMACY INC

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

## Provider details

- **NPI number:** 1669584587
- **Authorized official:** DALE PERSZYK (MANAGER)
- **Authorized official phone:** (715) 483-0426

## Contact information

- **Practice address:** 208 S ADAMS ST, SAINT CROIX FALLS, WI 54024-9449
- **Practice address phone:** (715) 483-0426
- **Mailing address:** 208 S ADAMS ST, SAINT CROIX FALLS, WI 54024-9449
- **Mailing address phone:** (715) 483-0426

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0002X | Clinic Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 7931042 | WI | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 03/26/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33069300 | — | WI |
| 01 | — | 5118509 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |