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General NPI Number Information
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NPI Number | 1083491096
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Entity Type | Individual
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Provider Name | LUKE ANTHONY JACOBSON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 1330 US HIGHWAY 41 W
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City | ISHPEMING
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State | MI
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Zip | 49849-3152
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Country | US
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Telephone | 906-485-5592
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Fax |
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Provider Business Mailing Address
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Address Line | 316 NORTH RD
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City | NEGAUNEE
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State | MI
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Zip | 49866-9505
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Country | US
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Telephone | 906-204-4810
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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 | 5302415468
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License Number State | MI
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