Provider Demographics
NPI:1336462779
Name:ABRAHAM, JACOB THOPPILKALATHIL (RPH)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:THOPPILKALATHIL
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 MONROE RD STE EF
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7853
Mailing Address - Country:US
Mailing Address - Phone:800-589-5737
Mailing Address - Fax:
Practice Address - Street 1:8157 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-0103
Practice Address - Country:US
Practice Address - Phone:704-243-2034
Practice Address - Fax:704-243-7853
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist