Provider Demographics
NPI:1679731012
Name:GROBELNY, JACOB E (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:E
Last Name:GROBELNY
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 1:146 FOX HUNT DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2535
Mailing Address - Country:US
Mailing Address - Phone:302-836-9387
Mailing Address - Fax:302-836-0713
Practice Address - Street 1:146 FOX HUNT DR
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2535
Practice Address - Country:US
Practice Address - Phone:302-836-9387
Practice Address - Fax:302-836-0713
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-31
Last Update Date:2008-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist