Provider Demographics
NPI:1417231788
Name:REUTER, JACOB PETER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:PETER
Last Name:REUTER
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 1:116 LAKE PARK PL
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-2138
Mailing Address - Country:US
Mailing Address - Phone:507-317-0176
Mailing Address - Fax:507-238-4701
Practice Address - Street 1:400 S STATE ST STE 50
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-2872
Practice Address - Country:US
Practice Address - Phone:507-238-2797
Practice Address - Fax:507-238-4701
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN180413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist