Rogue Valley Manor

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

RP0000882 Issued in OR

Legal business name

ROGUE VALLEY MANOR

Doing business as

Rogue Valley Manor Pharmacy

Practice address

1250 Mira Mar Ave
Medford, OR 97504-5520

Phone

(541) 857-7361

Fax

(541) 857-7362

NPI assigned

Feb 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fred Millan, RPH

Title

Director of Pharmacy

Phone

(541) 857-7361

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• ROGUE VALLEY MANOR PHARMACY Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Rogue Valley Manor2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Rogue Valley Manor

  • Skilled Nursing Facility
  • Medford, OR
  • NPI 1639170988
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460332800000",
    "number": "1265572150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 MIRA MAR AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975045520",
            "telephone_number": "541-857-7361",
            "fax_number": "541-857-7362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 MIRA MAR AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975045520",
            "telephone_number": "541-857-7361",
            "fax_number": "541-857-7362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGUE VALLEY MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2016-04-11",
        "status": "A",
        "authorized_official_last_name": "MILLAN",
        "authorized_official_first_name": "FRED",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "541-857-7361",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "RP0000882",
            "primary": true
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2078260",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "385250",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ROGUE VALLEY MANOR PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Medford, OR
• Providers in Medford, OR by specialty
• Community/Retail Pharmacy in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.