Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacob Fredericks

Individual provider Pharmacist · NPI 1356066120

Jacob Fredericks is a Pharmacist in Springfield, Illinois. Practices as a sole proprietor. Licensed in Illinois.

Licensed in
IL
In the registry since
2022
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Practice location Address checks out

3100 S Macarthur Blvd
Springfield, IL 62704-5800
Phone: (217) 528-4926
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pharmacist (primary) Taxonomy 183500000X · Licence 051.304276 (IL)

Record details

NPI number1356066120
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedOctober 5, 2022
Last updated in NPPESOctober 5, 2022
Certification dateOctober 5, 2022
Mailing address708 W Oak St, Gillespie, IL 62033-1240

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