Provider Demographics
NPI:1871227561
Name:SOUTH RIVER COMPOUNDING PHARMACY LLC
Entity type:Organization
Organization Name:SOUTH RIVER COMPOUNDING PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:LEIGHANN
Authorized Official - Middle Name:BENTON
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:804-897-6447
Mailing Address - Street 1:11420 W HUGUENOT RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-1119
Mailing Address - Country:US
Mailing Address - Phone:804-897-6447
Mailing Address - Fax:804-897-6449
Practice Address - Street 1:11420 W HUGUENOT RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-1119
Practice Address - Country:US
Practice Address - Phone:804-897-6447
Practice Address - Fax:804-897-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy