Provider Demographics
NPI:1639456734
Name:JACOBS, PAULINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SMITH AVE N # 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2344
Mailing Address - Country:US
Mailing Address - Phone:651-241-8849
Mailing Address - Fax:651-241-7160
Practice Address - Street 1:4205 EGAN DR
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2611
Practice Address - Country:US
Practice Address - Phone:952-746-2202
Practice Address - Fax:952-746-2208
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117453183500000X
FLPS56306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist