Healthcare Provider Details

I. General information

NPI: 1063352490
Provider Name (Legal Business Name): RACE JACOBSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S CLIFF AVE
SIOUX FALLS SD
57105-1007
US

IV. Provider business mailing address

4740 E 54TH ST APT 180
SIOUX FALLS SD
57110-4490
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-8349
  • Fax: 605-322-8370
Mailing address:
  • Phone: 605-322-8349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH6657
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7265
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: