Provider Demographics
NPI:1134111636
Name:PATTERSON, JACOB BETHEL JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:BETHEL
Last Name:PATTERSON
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 MOWBRAY ARCH
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-3322
Mailing Address - Country:US
Mailing Address - Phone:434-799-5786
Mailing Address - Fax:434-799-0253
Practice Address - Street 1:111 MALL DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4069
Practice Address - Country:US
Practice Address - Phone:434-792-6387
Practice Address - Fax:434-792-6389
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist