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NPI Code Detail

MEDICARE: JACOB THOMAS HOFERER

MEDICARE:   JACOB THOMAS HOFERER
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
11835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist021526KY
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist03440060OH

General Provider Information

NPI Number : 1881205433
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB THOMAS HOFERER
Provider Business Mailing Address
First Line : 120 E FREEDOM WAY UNIT 410
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-3453
Country : US
Telephone Number : 513-404-1723
Fax Number :
Provider Business Practice Location Address
First Line : 120 E FREEDOM WAY UNIT 410
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-3453
Country : US
Telephone Number : 513-404-1723
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2020
Last Update Date : 08/16/2020

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Directions to “ JACOB THOMAS HOFERER ” Practice Location

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