Provider Demographics
NPI:1417280652
Name:JACOB, JEAN K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:K
Last Name:JACOB
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 1:2117 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-3030
Mailing Address - Country:US
Mailing Address - Phone:203-493-4251
Mailing Address - Fax:
Practice Address - Street 1:2117 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-3030
Practice Address - Country:US
Practice Address - Phone:203-493-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0009700183500000X
NJ28RI02804900183500000X
IL051292532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist