Jacob Fehl, PHARMD
Individual provider Active NPI Pharmacist · Canton, IL
NPI 1437584075 · NPPES record last updated Sep 12, 2013
Key facts
- NPI
- 1437584075
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051.296927 (IL)
- Practice address
- 555 S Main St
Canton, IL 61520-3032 - Phone
- (309) 647-7610
- NPI assigned
- Sep 12, 2013
- Sex
- Male
- 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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.296927 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.296927 | IL | Yes |
Addresses
Primary practice location
555 S Main St
Canton, IL 61520-3032
Mailing address
6830 N Michele LN
Peoria, IL 61614-2623
Other providers in Canton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2013. 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.