Individual
DR. JACOB IVEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM D
Contact information
Practice address
3333 W DEYOUNG ST, MARION, IL 62959-5884
(618) 998-7821
Mailing address
11795 SONGBIRD RD, MARION, IL 62959-6877
(618) 694-1075
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2013011981
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051.291535
PHARMACIST
IL
01
—
2013011981
PHARMACIST
MO
01
—
PS60361
PHARMACIST
FL
Enumeration date
01/08/2020
Last updated
11/27/2023
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