Provider Demographics
NPI:1467774869
Name:JACOBI, GLENN B (RPH)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:B
Last Name:JACOBI
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 1:14 CAREY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10506
Mailing Address - Country:US
Mailing Address - Phone:914-234-4432
Mailing Address - Fax:
Practice Address - Street 1:969 MADISON AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-737-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040568OtherNEW YORK STATE PHARMACIST REGISTRATION NUMBER