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General NPI Number Information
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NPI Number | 1821721903
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Entity Type | Individual
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Provider Name | JACOB BRENNEN COOMES PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 135 RUTLEDGE AVE
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City | CHARLESTON
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State | SC
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Zip | 29425-8903
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Country | US
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Telephone | 843-792-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 601 MEETING ST APT 7057
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City | CHARLESTON
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State | SC
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Zip | 29403-6889
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Country | US
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Telephone | 601-415-5739
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 44446
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License Number State | TN
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