Healthcare Provider Details

I. General information

NPI: 1770409427
Provider Name (Legal Business Name): JERRY CHRISTOPHER BUCHOLC PHARM.D., BCGP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 MAGNOLIA AVE
MORTON IL
61550-1020
US

IV. Provider business mailing address

223 MAGNOLIA AVE
MORTON IL
61550-1020
US

V. Phone/Fax

Practice location:
  • Phone: 309-208-8300
  • Fax: 614-384-5669
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPS70363
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPU10515
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number5302418766
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number26031901A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number03446686
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number22984-40
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number024739
License Number StateKY
# 8
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number126962
License Number StateMN
# 9
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number051.286180
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: