Provider Demographics
NPI:1568731453
Name:ROBISON, JACOB MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:MICHAEL
Last Name:ROBISON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26146 N DESERT MESA DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-6821
Mailing Address - Country:US
Mailing Address - Phone:435-979-3305
Mailing Address - Fax:
Practice Address - Street 1:6202 S 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-4434
Practice Address - Country:US
Practice Address - Phone:602-268-0634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist