Active NPI
Thomas Jacobs, PHARMD
- Pharmacist
- East Peoria, IL
National Provider Identifier
1881297869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.299340
- Practice address
- 480 W Washington St
East Peoria, IL 61611-2445 - Phone
- (309) 407-3046
- NPI assigned
- Nov 20, 2020
- 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 | 051.299340 | IL | Primary |
Addresses
Primary practice location
480 W Washington St
East Peoria, IL 61611-2445
Mailing address
1007 Falcon Way Apt 5
Bloomington, IL 61704-6440
Phone (919) 402-6313
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.299340 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605830400000",
"number": "1881297869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1007 FALCON WAY APT 5",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617046440",
"telephone_number": "919-402-6313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "480 W WASHINGTON ST",
"city": "EAST PEORIA",
"state": "IL",
"postal_code": "616112445",
"telephone_number": "309-407-3046"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "THOMAS",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-20",
"last_updated": "2020-11-20",
"certification_date": "2020-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.299340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.