Provider Demographics
NPI:1619290368
Name:JACOB, LINSY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LINSY
Middle Name:
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 1:1933 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3519
Mailing Address - Country:US
Mailing Address - Phone:718-447-0300
Mailing Address - Fax:718-448-8146
Practice Address - Street 1:1933 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3519
Practice Address - Country:US
Practice Address - Phone:718-447-0300
Practice Address - Fax:718-448-8146
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052961-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist