Healthcare Provider Details

I. General information

NPI: 1477257632
Provider Name (Legal Business Name): JACOB ROBERTSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E IMPERIAL HWY STE 150
BREA CA
92821-6015
US

IV. Provider business mailing address

1800 E IMPERIAL HWY STE 150
BREA CA
92821-6015
US

V. Phone/Fax

Practice location:
  • Phone: 800-925-4733
  • Fax:
Mailing address:
  • Phone: 800-925-4733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: