Provider Demographics
NPI:1003160425
Name:MAREADY, JACOB DALE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:DALE
Last Name:MAREADY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 DOCTORS DR STE P
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1584
Mailing Address - Country:US
Mailing Address - Phone:252-523-3187
Mailing Address - Fax:
Practice Address - Street 1:701 DOCTORS DR STE P
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1584
Practice Address - Country:US
Practice Address - Phone:252-523-3187
Practice Address - Fax:252-522-2988
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist