South River Compounding Pharmacy, Inc

Primary specialty

PharmacistTaxonomy code 183500000X

License

0201003498 Issued in VA

Legal business name

SOUTH RIVER COMPOUNDING PHARMACY, INC

Practice address

11420 W Huguenot Rd
Midlothian, VA 23113-1119

Phone

(804) 897-6447

Fax

(804) 897-6449

NPI assigned

Oct 12, 2006

Organization subpart

No

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

Authorized official

Name

Baylor Rice Jr., RPH

Title

President

Phone

(804) 897-6447

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455494400000",
    "number": "1821187451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11420 W HUGUENOT RD",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231131119",
            "telephone_number": "804-897-6447",
            "fax_number": "804-897-6449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11420 W HUGUENOT RD",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231131119",
            "telephone_number": "804-897-6447",
            "fax_number": "804-897-6449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH RIVER COMPOUNDING PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2016-02-15",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "BAYLOR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "804-897-6447",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "0201003498",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8514585",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Midlothian, VA
• Providers in Midlothian, VA by specialty
• Pharmacist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2016; 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.