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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