Provider Demographics
NPI:1639589963
Name:JACOBS, JENNIFER LANGSTON (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LANGSTON
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 HART RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5429
Mailing Address - Country:US
Mailing Address - Phone:843-667-1819
Mailing Address - Fax:
Practice Address - Street 1:230 N BELTLINE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-7403
Practice Address - Country:US
Practice Address - Phone:843-664-0909
Practice Address - Fax:843-664-0911
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist