Jacob Fredericks

Pharmacist · Springfield, IL

Individual Active NPI

NPI number 1356066120

Practice location

3100 S Macarthur Blvd
Springfield, IL 62704-5800
Phone
(217) 528-4926

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NPI record

NPI
1356066120
Entity type
Individual (Type 1)
Enumeration date
October 5, 2022
Last updated
October 5, 2022
Certified
October 5, 2022
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Pharmacist Primary 183500000X 051.304276 IL

Mailing address

708 W Oak St
Gillespie, IL 62033-1240

About Jacob Fredericks

Jacob Fredericks is a healthcare provider registered in the NPI registry with the primary taxonomy Pharmacist (code 183500000X). The practice location is 3100 S Macarthur Blvd, Springfield, IL 62704-5800. The NPI number 1356066120 was assigned on October 5, 2022 and the record was last updated on October 5, 2022.

Jacob Fredericks lists a license in the registry: #051.304276 (IL) for Pharmacist. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Jacob Fredericks?

The NPI number is 1356066120.

What is the phone number of Jacob Fredericks?

The phone number listed for the practice location is (217) 528-4926.

Where is Jacob Fredericks located?

3100 S Macarthur Blvd, Springfield, IL 62704-5800.

What is the taxonomy code for Jacob Fredericks?

The primary taxonomy code is 183500000X – Pharmacist.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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