Provider Demographics
NPI:1710260237
Name:OSELL, JACOB MEYER (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:MEYER
Last Name:OSELL
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 1:328 WEST CONAN STREET
Mailing Address - Street 2:ELY BLOOMESON COMMUNITY HOSPITAL
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-1145
Mailing Address - Country:US
Mailing Address - Phone:218-365-8770
Mailing Address - Fax:218-365-8746
Practice Address - Street 1:328 W. CONAN ST.
Practice Address - Street 2:ELY BLOOMESON COMMUNITY HOSPITAL
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1145
Practice Address - Country:US
Practice Address - Phone:218-365-8770
Practice Address - Fax:218-365-8746
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist