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General NPI Number Information
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NPI Number | 1982350153
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Entity Type | Individual
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Provider Name | JEREMY TOLBERT MD
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Gender | Male
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Dates
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Enumeration Date | 02/26/2022
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Last Update Date | 02/26/2022
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Provider Practice Location Address
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Address Line | 14500 OAKLEY ST
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City | DIXMOOR
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State | IL
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Zip | 60426-1056
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Country | US
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Telephone | 773-426-2318
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Fax |
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Provider Business Mailing Address
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Address Line | 14500 OAKLEY ST
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City | DIXMOOR
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State | IL
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Zip | 60426-1056
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Country | US
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Telephone | 773-426-2318
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 9166763412
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License Number State | AR
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