Provider Demographics
NPI:1790113538
Name:RIVER VALLEY COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:RIVER VALLEY COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-678-3004
Mailing Address - Street 1:615 NORTH PLAZA DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956
Mailing Address - Country:US
Mailing Address - Phone:479-420-4428
Mailing Address - Fax:
Practice Address - Street 1:615 N PLAZA CT
Practice Address - Street 2:SUITE A
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-2600
Practice Address - Country:US
Practice Address - Phone:479-420-4428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy