Organization
ROGUE VALLEY MANOR
Active
Other names
ROGUE VALLEY MANOR PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
FRED MILLAN RPH (DIRECTOR OF PHARMACY)
(541) 857-7361
Entity
Organization
Contact information
Practice address
1250 MIRA MAR AVE, MEDFORD, OR 97504-5520
(541) 857-7361
(541) 857-7362
Mailing address
1250 MIRA MAR AVE, MEDFORD, OR 97504-5520
(541) 857-7361
(541) 857-7362
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP0000882
OR
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2078260
PK
—
05
—
385250
—
OR
Enumeration date
02/08/2007
Last updated
04/11/2016
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