Provider Demographics
NPI:1508643917
Name:RAMBERG, JACOB PATRICK (PHARMACY INTERN)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:PATRICK
Last Name:RAMBERG
Suffix:
Gender:M
Credentials:PHARMACY INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 EMORY ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49329-9413
Mailing Address - Country:US
Mailing Address - Phone:810-348-6769
Mailing Address - Fax:
Practice Address - Street 1:4166 17 MILE RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-9451
Practice Address - Country:US
Practice Address - Phone:616-696-9040
Practice Address - Fax:616-696-3250
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5351016961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist