Provider Demographics
NPI:1396864641
Name:JACOBSON, JANE E (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:E
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14700 60TH PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-3610
Mailing Address - Country:US
Mailing Address - Phone:425-741-0684
Mailing Address - Fax:
Practice Address - Street 1:8825 34TH AVE NE STE A
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271
Practice Address - Country:US
Practice Address - Phone:360-716-2660
Practice Address - Fax:360-716-3660
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00022563183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist