Provider Demographics
NPI:1467585869
Name:JACOBS, HOWARD PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:PAUL
Last Name:JACOBS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5256 MIRROR LAKE CT
Mailing Address - Street 2:23077 GREENFIELD ROAD SUITE 220
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323
Mailing Address - Country:US
Mailing Address - Phone:248-225-5283
Mailing Address - Fax:
Practice Address - Street 1:5256 MIRROR LAKE CT
Practice Address - Street 2:23077 GREENFIELD ROAD SUITE 220
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-1536
Practice Address - Country:US
Practice Address - Phone:248-225-5283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302021832OtherPHARMACIST LICENSE NUMBER