Provider Demographics
NPI:1154924025
Name:WEDDINGFELD, JAIME LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:LEE
Last Name:WEDDINGFELD
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 1:1130 S VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7117
Mailing Address - Country:US
Mailing Address - Phone:309-661-1839
Mailing Address - Fax:309-661-8160
Practice Address - Street 1:1130 S VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-7117
Practice Address - Country:US
Practice Address - Phone:309-661-1839
Practice Address - Fax:309-661-8160
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.297833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist