MEDICARE: JEFFREY GOVEDNIK RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051037803	IL

General Provider Information

NPI Number	:	1770186413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY GOVEDNIK RPH

Provider Business Mailing Address
First Line	:	21661 BUTTERNUT LN
Second Line	:
City	:	DELAVAN
State	:	IL
Zip	:	61734-1719
Country	:	US
Telephone Number	:	309-229-4954
Fax Number	:

Provider Business Practice Location Address
First Line	:	4521 N PROSPECT RD
Second Line	:
City	:	PEORIA HEIGHTS
State	:	IL
Zip	:	61616-6523
Country	:	US
Telephone Number	:	309-682-1250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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Directions to “ JEFFREY GOVEDNIK RPH” Practice Location

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