| Doctor Name: | DR. JEREMY RUTHERFORD |
| NPI Number: | 1063796621 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHARMD. |
| License Number: | 051291403 |
| Business Practice Address: | 300 N Main St East Peoria, IL - 616112016 |
| Business Phone Number: | 3096947661 |
| Business Fax Number: | |
| Mailing Address: | 300 N Main St, EAST PEORIA |
| State: | IL |
| Postal Code: | 616112016 |
| Phone Number: | 3093703538 |
| Fax Number: | |
| NPI Enumeration Date: | 09/30/2011 |
| NPI Last Update Date: | 09/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835G0303X |
| License Number: | 051291403 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Geriatric |
| Taxonomy Definition: | A pharmacist who is certified in geriatric pharmacy practice is designated as a |