Provider Demographics
NPI:1922733948
Name:FITZPATRICK, JACOB ROBERT (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ROBERT
Last Name:FITZPATRICK
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 1:3003 US-61
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3003 US-61
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761
Practice Address - Country:US
Practice Address - Phone:563-262-3755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist