Provider Demographics
NPI:1881205433
Name:HOFERER, JACOB THOMAS
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:THOMAS
Last Name:HOFERER
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 1:120 E FREEDOM WAY UNIT 410
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-3453
Mailing Address - Country:US
Mailing Address - Phone:513-404-1723
Mailing Address - Fax:
Practice Address - Street 1:120 E FREEDOM WAY UNIT 410
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-3453
Practice Address - Country:US
Practice Address - Phone:513-404-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0215261835P0018X
OH034400601835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist