Provider Demographics
NPI:1235300625
Name:NEESMITH, JACOB G (PHARMD,RPH)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:G
Last Name:NEESMITH
Suffix:
Gender:M
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2592 RILEY DR NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1813
Mailing Address - Country:US
Mailing Address - Phone:770-514-7379
Mailing Address - Fax:
Practice Address - Street 1:1000 WHITLOCK AVE NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5455
Practice Address - Country:US
Practice Address - Phone:770-421-7675
Practice Address - Fax:770-426-3678
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist