Provider Demographics
NPI:1952536682
Name:JAKUC, PAUL G (RPH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:JAKUC
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 1:600 E 125TH ST
Mailing Address - Street 2:MANHATTAN PSYCHIATRIC CENTER, WARDS ISLAND COMPLEX
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035
Mailing Address - Country:US
Mailing Address - Phone:646-672-6871
Mailing Address - Fax:646-672-5970
Practice Address - Street 1:600 E 125TH ST
Practice Address - Street 2:MANHATTAN PSYCHIATRIC CENTER, WARDS ISLAND COMPLEX
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035
Practice Address - Country:US
Practice Address - Phone:646-672-6871
Practice Address - Fax:646-672-5970
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY038455-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist