Healthcare Provider Details

I. General information

NPI: 1720900525
Provider Name (Legal Business Name): MR. JOHN PATRICK SHEAHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S FELL AVE
NORMAL IL
61761-6627
US

IV. Provider business mailing address

100 S FELL AVE
NORMAL IL
61761-6627
US

V. Phone/Fax

Practice location:
  • Phone: 309-452-0393
  • Fax:
Mailing address:
  • Phone: 309-452-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.309052
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: