Provider Demographics
NPI:1164514477
Name:LOHSER, JACOB (RPH, MBA)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:LOHSER
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15135 SHORE ACRES DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-1241
Mailing Address - Country:US
Mailing Address - Phone:216-791-3800
Mailing Address - Fax:216-231-3291
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:PHARMACY 119(W)
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:216-231-3291
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-12379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist