Healthcare Provider Details

I. General information

NPI: 1518695618
Provider Name (Legal Business Name): JEREMIAH JORDAN WOJTOWICZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E MAIN ST
DANVILLE IL
61832-5100
US

IV. Provider business mailing address

7042 YELLOW OAK LN
KNOXVILLE TN
37931-2557
US

V. Phone/Fax

Practice location:
  • Phone: 217-554-4170
  • Fax:
Mailing address:
  • Phone: 865-258-1955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46387
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: