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NPI Code Detail

MEDICARE: MRS. VIRGINIA ANNE JACOBY RPH

MEDICARE: MRS. VIRGINIA ANNE JACOBY RPH
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
1183500000XPharmacist039370NY

General Provider Information

NPI Number : 1932349560
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. VIRGINIA ANNE JACOBY RPH
Provider Business Mailing Address
First Line : 753 FORT SALONGA RD
Second Line :
City : NORTHPORT
State : NY
Zip : 11768-3148
Country : US
Telephone Number : 631-754-8374
Fax Number :
Provider Business Practice Location Address
First Line : 753 FORT SALONGA RD
Second Line :
City : NORTHPORT
State : NY
Zip : 11768-3148
Country : US
Telephone Number : 631-754-8374
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2009
Last Update Date : 02/22/2009

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