Provider Demographics
NPI:1912921420
Name:JACOBS, DENA M (RPH)
Entity Type:Individual
Prefix:MS
First Name:DENA
Middle Name:M
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 WHISPERING OAKS RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-2670
Mailing Address - Country:US
Mailing Address - Phone:608-835-8001
Mailing Address - Fax:608-226-5034
Practice Address - Street 1:5001 MONONA DR
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-2636
Practice Address - Country:US
Practice Address - Phone:608-226-5038
Practice Address - Fax:608-226-5034
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist