Provider Demographics
NPI:1154366334
Name:ROCK VALLEY PHCY INC
Entity type:Organization
Organization Name:ROCK VALLEY PHCY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHLACK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:712-476-5171
Mailing Address - Street 1:1418 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1418 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1224
Practice Address - Country:US
Practice Address - Phone:712-476-5171
Practice Address - Fax:712-476-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2753336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0291591Medicaid
1605394OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1605394OtherOTHER ID NUMBER-COMMERCIAL NUMBER