Provider Demographics
NPI:1912042128
Name:JACOBY, KIM LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:LYNN
Last Name:JACOBY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:LYNN
Other - Last Name:FREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:539 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-4005
Mailing Address - Country:US
Mailing Address - Phone:925-285-8930
Mailing Address - Fax:
Practice Address - Street 1:606 STATE ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1803
Practice Address - Country:US
Practice Address - Phone:541-436-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14238183500000X
CA50642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist