Provider Demographics
NPI:1619740172
Name:MALAND, JACOB DANIEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:DANIEL
Last Name:MALAND
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 1:2570 280TH ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MN
Mailing Address - Zip Code:56256-3013
Mailing Address - Country:US
Mailing Address - Phone:320-226-9244
Mailing Address - Fax:
Practice Address - Street 1:30116 EIGENBRODT WAY
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1225
Practice Address - Country:US
Practice Address - Phone:510-675-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist