Active NPI
Jerre Dale Atchison, R.PH.
- Pharmacist
- Carbondale, IL
National Provider Identifier
1902173198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051035825
- Practice address
- 1600 W Main St
Carbondale, IL 62901-2120 - Phone
- (618) 457-8397
- Fax
- (618) 549-3052
- NPI assigned
- Nov 16, 2011
- Last updated
- Nov 17, 2022
- 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 | 051035825 | IL | Primary |
Addresses
Primary practice location
1600 W Main St
Carbondale, IL 62901-2120
Mailing address
1900 State St RM 100
Chester, IL 62233-1116
Phone (618) 826-6134
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051035825 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital | Current | Accepting new patients |
Locations
1900 State St
Rm 100
Chester, IL 62233
Phone (618) 826-4581
Organizations & group practices 1
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.
-
- Institutional Pharmacy
- Chester, IL
- NPI 1023603289
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668643200000",
"number": "1902173198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 STATE ST RM 100",
"city": "CHESTER",
"state": "IL",
"postal_code": "622331116",
"telephone_number": "618-826-6134",
"fax_number": "618-826-1708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 W MAIN ST",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629012120",
"telephone_number": "618-457-8397",
"fax_number": "618-549-3052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ATCHISON",
"first_name": "JERRE",
"middle_name": "DALE",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-11-16",
"last_updated": "2022-11-17",
"certification_date": "2022-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051035825",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carbondale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.