| NAME |
ROCKFORD PHARMACY |
| STATE |
ILLINOIS |
| STREET ADDR. 1 |
4940 EAST STATE STREET |
| CITY |
ROCKFORD |
| ZIP |
61108-2270 |
| OFFICIAL VA NAME |
ROCKFORD PHARMACY |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
ROCKFORD VA CBOC PHARMACY |
| ST. ADDR. 1 (MAILING) |
4940 EAST STATE STREET |
| CITY (MAILING) |
ROCKFORD |
| STATE (MAILING) |
ILLINOIS |
| ZIP (MAILING) |
61108-2270 |
| EFFECTIVE DATE/TIME |
-
- 2006-08-22 00:00:00
- STATUS: ACTIVE
- NPI: 1033177589
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1033177589
|
