Provider Demographics
NPI:1447793625
Name:REASER, JACOB CHARLES (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:CHARLES
Last Name:REASER
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 1:5200 HENDERSON RD
Mailing Address - Street 2:APT 304
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-4049
Mailing Address - Country:US
Mailing Address - Phone:610-844-3285
Mailing Address - Fax:
Practice Address - Street 1:5535 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2603
Practice Address - Country:US
Practice Address - Phone:814-868-3488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4512111835P2201X
MAPH2360791835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH236079OtherMASSACHUSETTS PHARMACIST LICENSE
PARP451211OtherPENNSYLVANIA PHARMACIST LICENSE