Provider Demographics
NPI:1790399988
Name:RODEGHIERO, ABIGAIL NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:NICOLE
Last Name:RODEGHIERO
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 1:1823 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2842
Mailing Address - Country:US
Mailing Address - Phone:309-360-5772
Mailing Address - Fax:
Practice Address - Street 1:401 RIVER RD
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-2086
Practice Address - Country:US
Practice Address - Phone:309-694-0261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61352183500000X
IL051.302875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist