Provider Demographics
NPI:1689994311
Name:JACOBS, LIONEL HARVEY
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:HARVEY
Last Name:JACOBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 GAMBER RD
Mailing Address - Street 2:
Mailing Address - City:FINKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21048-2240
Mailing Address - Country:US
Mailing Address - Phone:410-861-8100
Mailing Address - Fax:410-861-8054
Practice Address - Street 1:3000 GAMBER RD
Practice Address - Street 2:
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-2240
Practice Address - Country:US
Practice Address - Phone:410-861-8100
Practice Address - Fax:410-861-8054
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist