Active NPI
Rex A Pence, BSPHARM
- Pharmacist
- Pontiac, IL
National Provider Identifier
1467667485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- Practice address
- 1034 W Reynolds St
Pontiac, IL 61764-9767 - Phone
- (815) 842-6774
- NPI assigned
- May 12, 2007
- Sex
- Male
- Sole proprietor
- No
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 | IL | Primary |
Addresses
Primary practice location
1034 W Reynolds St
Pontiac, IL 61764-9767
Mailing address
103 Fairview Ave
Bloomington, IL 61701-4208
Phone (309) 706-8914
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 |
|---|---|---|---|
| 051-034439 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467667485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 FAIRVIEW AVE",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617014208",
"telephone_number": "309-706-8914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1034 W REYNOLDS ST",
"city": "PONTIAC",
"state": "IL",
"postal_code": "617649767",
"telephone_number": "815-842-6774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENCE",
"first_name": "REX",
"middle_name": "A",
"credential": "BSPHARM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.