Healthcare Provider Details

I. General information

NPI: 1588390702
Provider Name (Legal Business Name): JACOB SIKES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 US 31W BYP
BOWLING GREEN KY
42101-1770
US

IV. Provider business mailing address

140 GRANDVIEW DR
SCOTTSVILLE KY
42164-6409
US

V. Phone/Fax

Practice location:
  • Phone: 270-796-6067
  • Fax:
Mailing address:
  • Phone: 270-606-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number023099
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number46175
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: