Provider Demographics
NPI:1649507674
Name:JACOB, SIJI (PHARM D)
Entity type:Individual
Prefix:MS
First Name:SIJI
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MS
Other - First Name:SIJI
Other - Middle Name:
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:3513 BAHAMA DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8995
Mailing Address - Country:US
Mailing Address - Phone:281-788-2856
Mailing Address - Fax:
Practice Address - Street 1:1025 W TRINITY MILLS
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-7500
Practice Address - Country:US
Practice Address - Phone:800-508-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist