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General NPI Number Information
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NPI Number | 1114792272
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Entity Type | Individual
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Provider Name | JACOB STEVEN DASILVA
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Gender | Male
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 1207 ACUSHNET AVE
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City | NEW BEDFORD
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State | MA
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Zip | 02746-2018
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Country | US
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Telephone | 508-984-5402
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Fax |
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Provider Business Mailing Address
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Address Line | 120 CLARA ST
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City | NEW BEDFORD
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State | MA
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Zip | 02744-2248
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Country | US
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Telephone | 774-992-6948
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | PI168146
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License Number State | MA
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