Provider Demographics
NPI:1124391065
Name:JACOBS, ELON (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELON
Middle Name:
Last Name:JACOBS
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 1:4149 HIGHLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-2103
Mailing Address - Country:US
Mailing Address - Phone:800-940-9963
Mailing Address - Fax:405-557-1083
Practice Address - Street 1:4149 HIGHLINE BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-2103
Practice Address - Country:US
Practice Address - Phone:800-940-9963
Practice Address - Fax:405-557-1083
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13649183500000X
NY055481183500000X
CA65154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist