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General NPI Number Information
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NPI Number | 1134674062
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Entity Type | Individual
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Provider Name | SHANNON NICOLE JACOBS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/21/2016
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Last Update Date | 08/21/2016
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Provider Practice Location Address
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Address Line | 3700 OWEN RD
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City | FENTON
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State | MI
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Zip | 48430-9193
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Country | US
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Telephone | 810-750-3735
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Fax | 810-750-7281
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Provider Business Mailing Address
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Address Line | 3700 OWEN RD
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City | FENTON
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State | MI
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Zip | 48430-9193
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Country | US
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Telephone | 810-750-3735
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Fax | 810-750-7281
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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 | 5302040211
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License Number State | MI
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