Provider Demographics
NPI:1316036650
Name:JAKOBSON DRUG & HALLMARK SHOP
Entity Type:Organization
Organization Name:JAKOBSON DRUG & HALLMARK SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-732-5452
Mailing Address - Street 1:635 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSAGE
Mailing Address - State:IA
Mailing Address - Zip Code:50461-1307
Mailing Address - Country:US
Mailing Address - Phone:641-732-5452
Mailing Address - Fax:
Practice Address - Street 1:635 MAIN ST
Practice Address - Street 2:
Practice Address - City:OSAGE
Practice Address - State:IA
Practice Address - Zip Code:50461-1307
Practice Address - Country:US
Practice Address - Phone:641-732-5452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1614672OtherNABP
IA0033993Medicaid