MEDICARE: MISS KATIE ANN JACOBS PHARMD

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	26024648A	IN

General Provider Information

NPI Number	:	1497000186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATIE ANN JACOBS PHARMD

Provider Business Mailing Address
First Line	:	8504 SCENIC VIEW DR APT 210
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-4239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 E 86TH ST STE 35
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1990
Country	:	US
Telephone Number	:	317-810-0045
Fax Number	:	317-810-8171

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

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	07/18/2012

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