Jason K Brannock, R.PH.
Individual provider Active NPI Pharmacist · Eldorado, IL
NPI 1285989673 · NPPES record last updated Jul 21, 2012
Key facts
- NPI
- 1285989673
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051.291023 (IL)
- Practice address
- 1021 US Highway 45 N
Eldorado, IL 62930-3767 - Phone
- (618) 273-3874
- Fax
- (618) 273-3843
- NPI assigned
- Jul 21, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
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
| License | State | Type | Specialty |
|---|---|---|---|
| 051.291023 | IL | MD | Pharmacist |
| 012873 | KY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Freds Stores of Tennessee Inc | Past | Accepting new patients | |
| Freds Stores of Tennessee Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.291023 | IL | Yes |
| Pharmacist | 183500000X | 012873 | KY |
Addresses
Primary practice location
1021 US Highway 45 N
Eldorado, IL 62930-3767
Mailing address
565 Karel Park Rd
Raleigh, IL 62977-1528
Other providers in Eldorado, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.