Thomas Edward Patterson
Individual provider Active NPI Pharmacist · Bartonville, IL
NPI 1639716244 · NPPES record last updated Dec 2, 2019
Key facts
- NPI
- 1639716244
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051034779 (IL)
- Practice address
- 1405 W Garfield Ave
Bartonville, IL 61607-1752 - Phone
- (309) 697-0589
- Fax
- (309) 697-1227
- NPI assigned
- Dec 2, 2019
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051034779 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Limited Partnership I | Past |
Accepting new patients | |
| Kroger Limited Partnership I | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051034779 | IL | Yes |
Addresses
Primary practice location
1405 W Garfield Ave
Bartonville, IL 61607-1752
Mailing address
21874 Robinwood LN
Delavan, IL 61734-1723
Phone (309) 241-5964
Other providers in Bartonville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2019. 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.