JACOB JEFFREY GENDRON (NPI# 1477963486) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477963486 |
| Entity Type | Individual |
| Full Name | JACOB JEFFREY GENDRON |
| Credential | PHARM.D |
| Practice Address |
3524 N University St Peoria IL 61604-1360 |
| Mailing Address |
1903 Wakefield Ln Bloomington IL 61704-9197 |
| Practice Telephone | 3096861933 |
| Mailing Telephone | 3095332600 |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2014-04-29 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 051.296632 | IL | Pharmacy Service Providers |
| Street Address |
3524 N UNIVERSITY ST |
| City | PEORIA |
| State | IL |
| Zip Code | 61604-1360 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316559925 | Fiyin Obajuluwa | Pharmacist | 3524 N University St, Peoria, IL 61604-1360 | 2020-08-17 |
| 1235740887 | Elizabeth Buchanan | Pharmacist | 3524 N University St, Peoria, IL 61604-1360 | 2020-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205357928 | Nydia I Rodriguez | Nurse's Aide | 3305 N Finnell Ave, Peoria, IL 61604 | 2017-07-03 |
| 1720327976 | Brin Diagnostics Inc. | Clinical Medical Laboratory | 3216 W Kenwood, West Peoria, IL 61604 | 2013-02-07 |
| 1225373715 | Ngocyen Thi Ngo | Pharmacist | 2515 N Knoxville Avenue, Peoria, IL 61604 | 2012-12-10 |
| 1194027003 | Schelly Chiropractic, Inc | Chiropractor | 1208 W Loucks, Peoria, IL 61604 | 2010-11-29 |
| 1770755852 | Dental Sealants & More | Dentist | 2126 N. University St., Peoria, IL 61604 | 2008-03-28 |
| 1821266123 | David L Krick | Dentist | 2022 N University, Peoria, IL 61604 | 2008-02-20 |
| 1568658409 | Advanced Physicians Health Care, S.c. | Chiropractor | 1200 West Loucks Ave, Peoria, IL 61604 | 2007-09-24 |
| 1902006000 | Noel Liu | Dentist | 3127 N. University St., Unit C, Peoria, IL 61604 | 2007-07-18 |
| 1568586386 | Susan B Bordenave-bishop | Dentist | 2116 N. Sheridan, Peoria, IL 61604 | 2007-03-19 |
| 1174689897 | Paul Anthony Amodeo | Dentist | 3100 N Dries Lane, Suite 301, Peoria, IL 61604 | 2006-12-28 |
| Find all providers in zip 61604 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386245397 | Lynsey Perera | Pharmacist | 7610 N Orange Prairie Rd, Peoria, IL 61615-9324 | 2020-11-05 |
| 1699375683 | Christopher Wayne Sharp | Pharmacist | 8062 W Eva St, Peoria, AZ 85345-7197 | 2020-10-28 |
| 1760093413 | Andrea Stump | Pharmacist | 24865 N Lake Pleasant Pkwy, Peoria, AZ 85383-1280 | 2020-08-14 |
| 1154957926 | Bhumit Kalavadiya | Pharmacist | 8375 W Pontiac Dr, Peoria, AZ 85382-1412 | 2020-03-12 |
| 1386290518 | Taylor Naberhaus | Pharmacist | 13640 N Plaza Del Rio Blvd # 210, Peoria, AZ 85381-4846 | 2019-08-13 |
| 1043767106 | Jason Mcaddley | Pharmacist | 9425 West Union Hills Drive, Peoria, AZ 85382 | 2016-09-07 |
| 1801263579 | John Leano | Pharmacist | 26898 N 87th Dr, Peoria, AZ 85383 | 2015-08-28 |
| 1245638782 | Adam Browning | Pharmacist | 12456 W Milton Dr, Peoria, AZ 85383-5009 | 2014-12-16 |
| 1447664784 | Rusvel Villamarin Santacruz | Pharmacist | 9313 W Ross Ave, Peoria, AZ 85382-5237 | 2014-06-15 |
| 1811300684 | Edward Monroe | Pharmacist | 316 W Ridgemont Rd, Peoria, IL 61614-7222 | 2014-06-09 |
| Find all providers in PEORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.