Provider Demographics
NPI:1194192690
Name:JACOBY, JOSETTE
Entity Type:Individual
Prefix:
First Name:JOSETTE
Middle Name:
Last Name:JACOBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 RONNY LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35146-7375
Mailing Address - Country:US
Mailing Address - Phone:205-919-3789
Mailing Address - Fax:205-833-2062
Practice Address - Street 1:9248 PARKWAY E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35206-1509
Practice Address - Country:US
Practice Address - Phone:205-833-0524
Practice Address - Fax:205-833-2062
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist