Active NPI
Darryl Paul Tjaden
- Pharmacist
- Vandalia, IL
National Provider Identifier
1467055160
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051029270
- Practice address
- 1401 N 8TH St
Vandalia, IL 62471-1028 - Phone
- (618) 283-0196
- Fax
- (618) 283-9150
- NPI assigned
- Nov 17, 2020
- Last updated
- Nov 17, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051029270 | IL | Primary |
Addresses
Primary practice location
1401 N 8TH St
Vandalia, IL 62471-1028
Mailing address
1401 N 8TH St
Vandalia, IL 62471-1028
Phone (618) 283-0196
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051029270 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bond County Pharmacy LLC | Current | Accepting new patients | |
| Bond County Pharmacy LLC | Current | Accepting new patients | |
| Cains Drug Store Inc | Current | Accepting new patients |
Locations
1401 N 8th St
Vandalia, IL 62471
Phone (618) 283-0196
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Long Term Care Pharmacy
- Greenville, IL
- NPI 1174324917
-
dba Bond County Pharmacy
- Community/Retail Pharmacy
- Greenville, IL
- NPI 1447846902
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605571200000",
"number": "1467055160",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1401 N 8TH ST",
"city": "VANDALIA",
"state": "IL",
"postal_code": "624711028",
"telephone_number": "618-283-0196",
"fax_number": "618-283-9150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 N 8TH ST",
"city": "VANDALIA",
"state": "IL",
"postal_code": "624711028",
"telephone_number": "618-283-0196",
"fax_number": "618-283-9150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TJADEN",
"first_name": "DARRYL",
"middle_name": "PAUL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-17",
"last_updated": "2020-11-17",
"certification_date": "2020-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051029270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vandalia, IL
- Stride Nutrition and Lifestyle Services LLC
- Ten Broeck Tennessee Physicians Group Inc (Center for Senior Renewal)
- Tepperberg Chiropractic Center
- The Brightside of Behavior
- The Elephant's Attic, Inc.
- Jessica Dawn Torbeck
- Total Renal Care Inc (Vandalia Dialysis)
- Transforming Physical Therapy LTD (Transforming Physical Therapy & Wellness)
- Vandalia Cusd 203
- Vandalia Dental Associates, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.