Provider Demographics
NPI:1083491096
Name:JACOBSON, LUKE ANTHONY (PHARMD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:ANTHONY
Last Name:JACOBSON
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 1:316 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-9505
Mailing Address - Country:US
Mailing Address - Phone:906-204-4810
Mailing Address - Fax:
Practice Address - Street 1:1330 US HIGHWAY 41 W
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-3152
Practice Address - Country:US
Practice Address - Phone:906-485-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302415468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist