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General NPI Number Information
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NPI Number | 1396056701
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Entity Type | Individual
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Provider Name | MARILYN FRANCES JACOBS
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Gender | Female
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 1133 N MOUNT VERNON AVE
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City | COLTON
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State | CA
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Zip | 92324-2554
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Country | US
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Telephone | 909-825-6371
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Fax |
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Provider Business Mailing Address
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Address Line | 26276 KING EDWARDS DR
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City | LOMA LINDA
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State | CA
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Zip | 92354-4157
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Country | US
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Telephone | 909-796-0104
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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 | 36999
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License Number State | CA
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