Jacqueline Renee Brown, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

051.294547 Issued in IL

Practice address

612 N 11TH St
Quincy, IL 62301-2662

Phone

(217) 224-9484

NPI assigned

Sep 27, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jacqueline Renee Vardaros Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Highland Park CVS LLC

  • Pharmacy
  • Quincy, IL
  • NPI 1184665051
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664236800000",
    "number": "1033833736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4215 BUNKER DR",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623051023",
            "telephone_number": "208-390-1827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 N 11TH ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623012662",
            "telephone_number": "217-224-9484"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "436 N 30th St",
            "address_purpose": "LOCATION",
            "city": "Quincy",
            "state": "IL",
            "postal_code": "623013602",
            "country_code": "US",
            "telephone_number": "217-224-2828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROWN",
        "first_name": "JACQUELINE",
        "middle_name": "RENEE",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-27",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051.294547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "VARDAROS",
            "middle_name": "RENEE",
            "credential": "PHARMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Matthew T. Brink, DO
• Broadway Vision Center
• Whitney Brock
• Ashley N. Brown, CNP
• Glenda Brown, NP
• Sara Brown, APRN
• Tiffany Rochelle Browning
• Kolton Chase Bruce, HIS
• Bruening Total Wellness Center LLC
• Brandon Bruening, D.C.

• Pharmacist in Quincy, IL
• Providers in Quincy, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.