Provider Demographics
NPI:1891334447
Name:HALL, JACOB W (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:W
Last Name:HALL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1132
Mailing Address - Country:US
Mailing Address - Phone:502-827-9994
Mailing Address - Fax:
Practice Address - Street 1:3040 DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7135
Practice Address - Country:US
Practice Address - Phone:270-737-4578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019523333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy