Provider Demographics
NPI:1871505172
Name:JACOBS, BETH A (R PH)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:JACOBS
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 MYERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-7335
Mailing Address - Country:US
Mailing Address - Phone:214-908-6824
Mailing Address - Fax:972-243-3177
Practice Address - Street 1:221 W COLORADO BLVD
Practice Address - Street 2:SUITE 445
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2363
Practice Address - Country:US
Practice Address - Phone:214-947-2435
Practice Address - Fax:214-947-2436
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist