Provider Demographics
NPI:1952453219
Name:JACOFF, GUSTAVE N (RPH)
Entity Type:Individual
Prefix:MR
First Name:GUSTAVE
Middle Name:N
Last Name:JACOFF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 EMPIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5653
Mailing Address - Country:US
Mailing Address - Phone:718-774-3311
Mailing Address - Fax:718-467-0741
Practice Address - Street 1:839 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5653
Practice Address - Country:US
Practice Address - Phone:718-774-3311
Practice Address - Fax:718-467-0741
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist