Provider Demographics
NPI:1417272345
Name:JACOBS, BRIDGETTE ANNETTE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:ANNETTE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3802
Mailing Address - Country:US
Mailing Address - Phone:281-208-5828
Mailing Address - Fax:
Practice Address - Street 1:6120 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3802
Practice Address - Country:US
Practice Address - Phone:281-208-5828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-03
Last Update Date:2010-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX18OtherPHARMACIST
TX18Medicaid
TX18Medicaid