Jared Andrew Blaylock, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

2020023097 Issued in MO

Practice address

1 W Edwardsville Rd
Wood River, IL 62095-1261

Phone

(618) 254-3610

NPI assigned

Nov 30, 2020

Last updated

Feb 17, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

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.

• Highland Park CVS, L.L.C.

  dba CVS Pharmacy 06833

  • Pharmacy
  • Wood River, IL
  • NPI 1710080585
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1770187783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 W EDWARDSVILLE RD",
            "city": "WOOD RIVER",
            "state": "IL",
            "postal_code": "620951261",
            "telephone_number": "618-254-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 W EDWARDSVILLE RD",
            "city": "WOOD RIVER",
            "state": "IL",
            "postal_code": "620951261",
            "telephone_number": "618-254-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAYLOCK",
        "first_name": "JARED",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-30",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051303330",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2020023097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie A Baker, RPH
• Katie Lynn Bartels, PHARMD
• Rachael Ann Beard, RN, BSN, M.ED
• Behavioral Health Alternatives, Inc
• Beverly Enterprises - Illinois, Inc. (VIP Manor)
• Bravo Care of Wood River Inc
• Bria of Woodriver LP
• Bob Burris, M.D.
• Laura Burton
• Keith N Byler, D. O.

• Pharmacist in Wood River, IL
• Providers in Wood River, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.