Provider Demographics
NPI:1568065019
Name:JACOBSON-WARE, CHRISTINE RENEE (RPH, DAAFM)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RENEE
Last Name:JACOBSON-WARE
Suffix:
Gender:F
Credentials:RPH, DAAFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5181
Mailing Address - Country:US
Mailing Address - Phone:801-479-0331
Mailing Address - Fax:855-273-1877
Practice Address - Street 1:1028 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5181
Practice Address - Country:US
Practice Address - Phone:801-479-0331
Practice Address - Fax:855-273-1877
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT334748-17011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty