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NPI Code Detail

MEDICARE: ANJU JACOB

MEDICARE: ANJU JACOB
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
1183500000XPharmacistRP100485PA

General Provider Information

NPI Number : 1629481684
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANJU JACOB
Provider Business Mailing Address
First Line : 6515 CASTOR AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-2708
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6515 CASTOR AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-2708
Country : US
Telephone Number : 215-745-6556
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2014
Last Update Date : 06/07/2014

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Directions to “ ANJU JACOB ” Practice Location

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