Jane Margaret Johnson, RPH

Key facts

NPI

1104462282

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist 183500000X

License

051-036315 (IL)

Practice address

603 S 4TH St
Chillicothe, IL 61523-2267

Phone

(309) 274-3419

NPI assigned

Nov 22, 2019

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Registered Pharmacist

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 22, 2019.

{
    "created_epoch": "1574380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574380800000",
    "number": "1104462282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4717 W BRIDALWOOD DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616152707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 S 4TH ST",
            "city": "CHILLICOTHE",
            "state": "IL",
            "postal_code": "615232267",
            "telephone_number": "309-274-3419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JANE",
        "middle_name": "MARGARET",
        "name_prefix": "Mrs.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-22",
        "last_updated": "2019-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051-036315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED PHARMACIST",
            "identifier": "051-036315",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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