Healthcare Provider Details

I. General information

NPI: 1861327231
Provider Name (Legal Business Name): JACOB VAN OORT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 10TH ST SE
CEDAR RAPIDS IA
52403-1292
US

IV. Provider business mailing address

4214 WOODSONIA CT NW
CEDAR RAPIDS IA
52405-5524
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-6011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License Number24513
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: