Provider Demographics
NPI:1346538741
Name:HAMPTON, JACOB DAVID (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:DAVID
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4737 VALLEY VIEW BLVD NW
Mailing Address - Street 2:T-1162
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-2000
Mailing Address - Country:US
Mailing Address - Phone:334-332-8851
Mailing Address - Fax:
Practice Address - Street 1:4737 VALLEY VIEW BLVD NW
Practice Address - Street 2:T-1162
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-2000
Practice Address - Country:US
Practice Address - Phone:334-332-8851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210698183500000X
GARPH026136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist