Provider Demographics
NPI:1326281601
Name:JACOBS, STEPHANUS
Entity Type:Individual
Prefix:MR
First Name:STEPHANUS
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 WALNUT BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-9145
Mailing Address - Country:US
Mailing Address - Phone:717-241-2559
Mailing Address - Fax:717-241-2559
Practice Address - Street 1:429 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3917
Practice Address - Country:US
Practice Address - Phone:717-258-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist