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General NPI Number Information
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NPI Number | 1568065019
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Entity Type | Individual
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Provider Name | CHRISTINE RENEE JACOBSON-WARE RPH, DAAFM
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Gender | Female
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 1028 CHAMBERS ST
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City | OGDEN
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State | UT
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Zip | 84403-5181
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Country | US
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Telephone | 801-479-0331
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Fax | 855-273-1877
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Provider Business Mailing Address
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Address Line | 1028 CHAMBERS ST
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City | OGDEN
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State | UT
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Zip | 84403-5181
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Country | US
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Telephone | 801-479-0331
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Fax | 855-273-1877
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 334748-1701
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License Number State | UT
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