MEDICARE: MRS. JULIA MARI-FANNISE JACOBS PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	38006	TX

General Provider Information

NPI Number	:	1134721038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIA MARI-FANNISE JACOBS PHARMACIST

Provider Business Mailing Address
First Line	:	6746 HOLLYGROVE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77061-2807
Country	:	US
Telephone Number	:	832-651-6748
Fax Number	:

Provider Business Practice Location Address
First Line	:	13750 I 10 E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-5929
Country	:	US
Telephone Number	:	713-453-2316
Fax Number	:	713-453-5403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2020
Last Update Date	:	11/15/2020

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