Provider Demographics
NPI:1326472523
Name:JACOB, JESWIN CHAMATHIL
Entity Type:Individual
Prefix:
First Name:JESWIN
Middle Name:CHAMATHIL
Last Name:JACOB
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 1:7845 N MACARTHUR BLVD
Mailing Address - Street 2:TARGET PHARMACY T1032
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7845 N MACARTHUR BLVD
Practice Address - Street 2:TARGET PHARMACY T1032
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7516
Practice Address - Country:US
Practice Address - Phone:972-506-9924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-25
Last Update Date:2013-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist