Active NPI
Jonathan Botterbush, PHARMD
- Pharmacist
- Granite City, IL
National Provider Identifier
1013838176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051309057
- Practice address
- 3319 Nameoki Rd
Granite City, IL 62040-3708 - Phone
- (618) 452-1198
- NPI assigned
- Jul 23, 2026
- Last updated
- Jul 23, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051309057 | IL | Primary |
Addresses
Primary practice location
3319 Nameoki Rd
Granite City, IL 62040-3708
Mailing address
3319 Nameoki Rd
Granite City, IL 62040-3708
Phone (618) 452-1198
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051309057 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Highland Park CVS LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1784764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784764800000",
"number": "1013838176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3319 NAMEOKI RD",
"city": "GRANITE CITY",
"state": "IL",
"postal_code": "620403708",
"telephone_number": "618-452-1198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3319 NAMEOKI RD",
"city": "GRANITE CITY",
"state": "IL",
"postal_code": "620403708",
"telephone_number": "618-452-1198"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOTTERBUSH",
"first_name": "JONATHAN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-07-23",
"last_updated": "2026-07-23",
"certification_date": "2026-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051309057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granite City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.