NPIMap

Organization Active NPI

Rock Valley Compounding Pharmacy LLC

  • Compounding Pharmacy
  • Rockford, IL
National Provider Identifier
1376802462
Registry record updated Aug 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Compounding PharmacyTaxonomy code 3336C0004X
Legal business name
ROCK VALLEY COMPOUNDING PHARMACY LLC
Practice address
811 S Perryville Rd Unit 109
Rockford, IL 61108-4323
Phone
(779) 423-0542
Fax
(779) 545-2277
NPI assigned
May 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2022

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

Authorized official

Name
Jonathan M Lehan, PHARMDNPI 1518025972
Title
Pharmacist in Charge
Phone
(779) 423-0542

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 054018235 IL
Compounding Pharmacy 3336C0004X Primary

Addresses

Primary practice location

811 S Perryville Rd Unit 109
Rockford, IL 61108-4323

Mailing address

811 S Perryville Rd Unit 109
Rockford, IL 61108-4323
Phone (779) 423-0542

Other identifiers 2

IdentifierTypeStateIssuer
2135285OtherPK
362674647002MedicaidIL

Other names 1

  • Rock Valley Compounding Pharmacy LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1336521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659571200000",
    "number": "1376802462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 S PERRYVILLE RD UNIT 109",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611084323",
            "telephone_number": "779-423-0542",
            "fax_number": "779-545-2277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 S PERRYVILLE RD UNIT 109",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611084323",
            "telephone_number": "779-423-0542",
            "fax_number": "779-545-2277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCK VALLEY COMPOUNDING PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-09",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A",
        "authorized_official_last_name": "LEHAN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "779-423-0542",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054018235",
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135285",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "362674647002",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rock Valley Compounding Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rock Valley Compounding Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.