Healthcare Provider Details

I. General information

NPI: 1922733948
Provider Name (Legal Business Name): JACOB ROBERT FITZPATRICK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1996 240TH ST
WASHINGTON IA
52353-9406
US

IV. Provider business mailing address

1996 240TH ST
WASHINGTON IA
52353-9406
US

V. Phone/Fax

Practice location:
  • Phone: 319-653-4646
  • Fax: 319-653-3926
Mailing address:
  • Phone: 319-653-4646
  • Fax: 319-653-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24466
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: