Healthcare Provider Details

I. General information

NPI: 1669503306
Provider Name (Legal Business Name): JASON JOSEPH DEGENHART PHARM. D. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 WILD HORSE ST
NORMAL IL
61761-9656
US

IV. Provider business mailing address

2939 WILD HORSE ST
NORMAL IL
61761-9656
US

V. Phone/Fax

Practice location:
  • Phone: 309-451-1722
  • Fax:
Mailing address:
  • Phone: 309-451-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: