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General NPI Number Information
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NPI Number | 1811643182
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Entity Type | Individual
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Provider Name | REAGAN JACOBS
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Gender | Female
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 628 HIGHWAY 51 N
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City | RIPLEY
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State | TN
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Zip | 38063-5904
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Country | US
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Telephone | 731-635-8904
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Fax |
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Provider Business Mailing Address
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Address Line | 98 OKELLEY CV
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City | ATOKA
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State | TN
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Zip | 38004-7481
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Country | US
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Telephone | 731-612-0734
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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 | 0000045439
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License Number State | TN
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