Provider Demographics
NPI:1972833804
Name:JACOBSON, ANITA N (PHAMD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:N
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GREENHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881-2018
Mailing Address - Country:US
Mailing Address - Phone:401-874-2641
Mailing Address - Fax:401-572-3351
Practice Address - Street 1:7 GREENHOUSE RD
Practice Address - Street 2:295B
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881-2018
Practice Address - Country:US
Practice Address - Phone:401-874-2641
Practice Address - Fax:401-874-5670
Is Sole Proprietor?:No
Enumeration Date:2009-12-25
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH040301835P1200X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRPH04030OtherLICENSE