Provider Demographics
NPI:1730469487
Name:JOCKISCH, RHONDA DIANE (RPH)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:DIANE
Last Name:JOCKISCH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-5215
Mailing Address - Country:US
Mailing Address - Phone:309-349-5589
Mailing Address - Fax:309-347-3957
Practice Address - Street 1:2020 COURT ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-5215
Practice Address - Country:US
Practice Address - Phone:309-347-5589
Practice Address - Fax:309-347-3957
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051038943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist