Provider Demographics
NPI:1508315276
Name:JACOB, ANIE J (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ANIE
Middle Name:J
Last Name:JACOB
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3823
Mailing Address - Country:US
Mailing Address - Phone:267-254-0456
Mailing Address - Fax:215-925-1055
Practice Address - Street 1:344 SALEM RD
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3823
Practice Address - Country:US
Practice Address - Phone:267-254-0456
Practice Address - Fax:215-925-1055
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037930-R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist