Healthcare Provider Details

I. General information

NPI: 1174857080
Provider Name (Legal Business Name): JASON ALAN ROEING PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E EMPIRE ST
BLOOMINGTON IL
61704
US

IV. Provider business mailing address

4710 WHITE HORSE DR
GREENSBORO NC
27410-9540
US

V. Phone/Fax

Practice location:
  • Phone: 309-662-7004
  • Fax: 309-662-6650
Mailing address:
  • Phone: 336-545-4460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.297481
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: