Provider Demographics
NPI:1952828972
Name:VEATCH, JACOB L (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:L
Last Name:VEATCH
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:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:NUCLA
Mailing Address - State:CO
Mailing Address - Zip Code:81424-0429
Mailing Address - Country:US
Mailing Address - Phone:970-864-2100
Mailing Address - Fax:
Practice Address - Street 1:480 MAIN
Practice Address - Street 2:
Practice Address - City:NUCLA
Practice Address - State:CO
Practice Address - Zip Code:81424-0429
Practice Address - Country:US
Practice Address - Phone:970-864-2100
Practice Address - Fax:970-864-2100
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2006021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist