Organization
JAVON BEA HOSPITAL
Active
Parent organization
MERCY HEALTH CORPORATION
Other names
Mercyhealth Pharmacy - Riverside
Organization subpart
Yes
Provider details
NPI number
Legal business name
MERCY HEALTH CORPORATION
Authorized official
JOSEPH D MALAS (CFO)
(815) 971-6738
Entity
Organization
Contact information
Practice address
8201 E RIVERSIDE BLVD STE 1022, ROCKFORD, IL 61114-2300
(815) 971-1100
(815) 971-9084
Mailing address
8201 E RIVERSIDE BLVD STE 1022, ROCKFORD, IL 61114-2300
(815) 971-1100
(815) 971-9084
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054020724
IL STATE LICENSE
IL
01
—
1494842
NCPDP
—
01
—
7726440001
IL MEDICARE
IL
Enumeration date
11/27/2018
Last updated
06/10/2025
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