CHRISTOPHER JACOBSEN (NPI# 1124644273) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124644273 |
| Entity Type | Individual |
| Full Name | CHRISTOPHER JACOBSEN |
| Practice Address |
300 N Main St East Peoria IL 61611-2081 |
| Mailing Address |
503 Northwestern St Spring Valley IL 61362-1013 |
| Practice Telephone | 3096947661 |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2020-06-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 051302501 | IL | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518457118 | Christopher L Jacobsen | Dentist | 3473 W S Jordan Pkwy Ste 2, South Jordan, UT 84095-6016 | 2018-05-18 |
| Street Address |
300 N MAIN ST |
| City | EAST PEORIA |
| State | IL |
| Zip Code | 61611-2081 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326522665 | Danielle Nicole Kirgan | Pharmacist | 300 N Main St, East Peoria, IL 61611-2081 | 2018-09-22 |
| 1013293067 | Scott Allen Johnson | Pharmacist | 300 N Main St, East Peoria, IL 61611-2016 | 2011-10-21 |
| 1376828285 | Anna Lisa Fisher | Pharmacist | 300 N Main St, East Peoria, IL 61611-2016 | 2011-10-12 |
| 1306121256 | Sarah White | Pharmacist | 300 N Main St, East Peoria, IL 61611-2016 | 2011-10-11 |
| 1699059295 | Michael Joseph Kies | Pharmacist | 300 N Main St, East Peoria, IL 61611-2016 | 2011-10-01 |
| 1063796621 | Jeremy Rutherford | Pharmacist | 300 N Main St, East Peoria, IL 61611-2016 | 2011-09-30 |
| 1285917112 | Brian William Rous | Pharmacist | 300 N Main St, East Peoria, IL 61611-2016 | 2011-09-27 |
| 1063795482 | Anne Marie Blue | Pharmacist | 300 N Main St, East Peoria, IL 61611-2016 | 2011-09-21 |
| 1851548598 | Mary K Davis | Nurse Practitioner | 300 N Main St, East Peoria, IL 61611-2016 | 2008-08-25 |
| 1447265624 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 300 N Main St, East Peoria, IL 61611-2016 | 2006-07-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548736390 | Osf Multi-specialty Group | Non-Pharmacy Dispensing Site | 133 Spinder Drive Ste 4015, East Peoria, IL 61611 | 2018-10-19 |
| 1083128474 | Abc Counseling & Family Services | Clinic/Center | 111 W. Washington St., Suite 410b, East Peoria, IL 61611 | 2017-11-22 |
| 1386162253 | Cheryl Denise Hagedorn | Speech-Language Pathologist | 306 Eckley Avenue, East Peoria, IL 61611 | 2017-08-31 |
| 1710342076 | Rebecca Uthe | Physical Therapist | 901 Illini Drive, East Peoria, IL 61611 | 2015-12-30 |
| 1669812103 | Christopher Webb | Dentist | 360 West Washington Street, East Peoria, IL 61611 | 2013-06-28 |
| 1386985380 | Dental Professionals of Illinois, P.C. | Dentist | 368 W. Washington St., East Peoria, IL 61611 | 2013-03-15 |
| 1730432675 | Synergy Healthcare Physical Medicine Sc | Chiropractor | 350 Cimmeron Drive, East Peoria, IL 61611 | 2012-10-16 |
| 1508122029 | Daniel Benjamin Gans | Radiology | 111 Oakwood Rd, East Peoria, IL 61611 | 2012-04-10 |
| 1326288390 | Sara Sabry Fouad Rizk | Pharmacist | 2540 East Washington Street, East Peoria, IL 61611 | 2009-03-03 |
| 1356466007 | Tazwood Mental Health Center, Inc. | Counselor | 111 W. Washington Street, Suite 230, East Peoria, IL 61611 | 2007-03-20 |
| Find all providers in zip 61611 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841631082 | Kimberly Marie Scully | Pharmacist | 130 Eastwood Dr, East Peoria, IL 61611-1586 | 2013-07-16 |
| 1326288390 | Sara Sabry Fouad Rizk | Pharmacist | 2540 East Washington Street, East Peoria, IL 61611 | 2009-03-03 |
| 1356460752 | Carl Richard Jordan | Pharmacist | 302 Harbor Pointe Dr, East Peoria, IL 61611-5802 | 2007-03-28 |
| 1790399988 | Abigail Nicole Rodeghiero | Pharmacist | 401 River Rd, East Peoria, IL 61611-2086 | 2020-09-04 |
| 1235743600 | Lauren Nicole Miklavcic | Pharmacist | 301 W Washington St, East Peoria, IL 61611-2036 | 2020-09-03 |
| 1750927687 | Daniel Kowalenko | Pharmacist | 201 S Main St, East Peoria, IL 61611-2458 | 2019-11-26 |
| 1841836707 | Troy Kramer | Pharmacist | 201 S Main St, East Peoria, IL 61611-2458 | 2019-11-25 |
| 1316583594 | Andrea C Redell | Pharmacist | 201 S Main St, East Peoria, IL 61611-2458 | 2019-11-21 |
| 1326522665 | Danielle Nicole Kirgan | Pharmacist | 300 N Main St, East Peoria, IL 61611-2081 | 2018-09-22 |
| 1154794790 | Linda Sok | Pharmacist | 401 River Rd, East Peoria, IL 61611-2063 | 2015-11-04 |
| Find all providers in EAST PEORIA | ||||
| City | EAST PEORIA |
| Zip Code | 61611 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.