Provider Demographics
NPI:1659617223
Name:NOWELL, JAYME SUE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAYME
Middle Name:SUE
Last Name:NOWELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-2416
Mailing Address - Country:US
Mailing Address - Phone:309-427-2931
Mailing Address - Fax:309-427-2932
Practice Address - Street 1:201 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-2416
Practice Address - Country:US
Practice Address - Phone:309-427-2931
Practice Address - Fax:309-427-2932
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-29
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294923183500000X
MO2010034683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist