Provider Demographics
NPI:1629398870
Name:JACOBS, JOSHUA ALLEN (PHARM D)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ALLEN
Last Name:JACOBS
Suffix:
Gender:M
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 1:2095 PINE LN
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-1970
Mailing Address - Country:US
Mailing Address - Phone:205-478-4897
Mailing Address - Fax:
Practice Address - Street 1:5271 ROSS BRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-5011
Practice Address - Country:US
Practice Address - Phone:205-988-9013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist