Provider Demographics
NPI:1770186413
Name:GOVEDNIK, JEFFREY (RPH)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GOVEDNIK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21661 BUTTERNUT LN
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61734-1719
Mailing Address - Country:US
Mailing Address - Phone:309-229-4954
Mailing Address - Fax:
Practice Address - Street 1:4521 N PROSPECT RD
Practice Address - Street 2:
Practice Address - City:PEORIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61616-6523
Practice Address - Country:US
Practice Address - Phone:309-682-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist