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General NPI Number Information
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NPI Number | 1235615378
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Entity Type | Individual
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Provider Name | JACOB THOMAS MAHR PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 1501 CRESTON PARK DR
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City | JANESVILLE
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State | WI
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Zip | 53545-1151
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Country | US
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Telephone | 608-752-7431
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Fax |
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Provider Business Mailing Address
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Address Line | 662 QUEENS CT
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City | ROCKTON
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State | IL
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Zip | 61072-1608
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Country | US
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Telephone | 309-333-5931
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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 | 051300216
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19184-40
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License Number State | WI
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