Provider Demographics
NPI:1609650043
Name:KRIER, JACOB (RPH)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:KRIER
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 1:325 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-9656
Mailing Address - Country:US
Mailing Address - Phone:541-469-1643
Mailing Address - Fax:541-469-1637
Practice Address - Street 1:325 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9656
Practice Address - Country:US
Practice Address - Phone:541-469-1643
Practice Address - Fax:541-469-1637
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0019650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty