Provider Demographics
NPI:1316393648
Name:JACOBSON, TAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TAM
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11631 MIRO CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3320
Mailing Address - Country:US
Mailing Address - Phone:858-761-4003
Mailing Address - Fax:
Practice Address - Street 1:11631 MIRO CIR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3320
Practice Address - Country:US
Practice Address - Phone:858-761-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532711835C0205X, 1835P1200X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835C0205XPharmacy Service ProvidersPharmacistCritical Care
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care