Mark Steven Tedrow, RPH

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

051-033423 Issued in IL

Practice address

1880 S West Ave
Freeport, IL 61032-6712

Phone

(815) 235-4299

Fax

(815) 233-4675

NPI assigned

Feb 20, 2010

Last updated

Feb 20, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

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

{
    "created_epoch": "1266624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266624000000",
    "number": "1073835880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1880 S WEST AVE",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610326712",
            "telephone_number": "815-235-4299",
            "fax_number": "815-233-4675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1880 S WEST AVE",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610326712",
            "telephone_number": "815-235-4299",
            "fax_number": "815-233-4675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDROW",
        "first_name": "MARK",
        "middle_name": "STEVEN",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-20",
        "last_updated": "2010-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "IL",
            "license": "051-033423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Freeport, IL
• Providers in Freeport, IL by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2010; 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.