Provider Demographics
NPI:1982160107
Name:MEYER, JACOB ARNOLD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ARNOLD
Last Name:MEYER
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 1:545 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:PINE ISLAND
Mailing Address - State:MN
Mailing Address - Zip Code:55963-9112
Mailing Address - Country:US
Mailing Address - Phone:563-379-4795
Mailing Address - Fax:
Practice Address - Street 1:6055 NATHAN LN N # 200A
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-1674
Practice Address - Country:US
Practice Address - Phone:763-513-4300
Practice Address - Fax:763-513-4380
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23176183500000X
MN123688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist