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General NPI Number Information
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NPI Number | 1063234664
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Entity Type | Individual
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Provider Name | BRAD PERRY JACOBSON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/26/2024
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Last Update Date | 10/26/2024
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Provider Practice Location Address
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Address Line | 5334 FM 1103
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City | SCHERTZ
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State | TX
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Zip | 78108-2444
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Country | US
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Telephone | 210-672-6596
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Fax |
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Provider Business Mailing Address
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Address Line | 922 E SONTERRA BLVD APT 3305
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City | SAN ANTONIO
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State | TX
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Zip | 78258-5008
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Country | US
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Telephone | 702-525-6989
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 74862
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License Number State | TX
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