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General NPI Number Information
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NPI Number | 1922315571
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Entity Type | Individual
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Provider Name | JACOB ROBERT ALBERT PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 2104 E NC 54 HIGHWAY
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City | DURHAM
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State | NC
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Zip | 27713-2206
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Country | US
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Telephone | 919-361-5304
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Fax | 919-806-0851
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Provider Business Mailing Address
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Address Line | 2104 E NC 54 HIGHWAY
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City | DURHAM
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State | NC
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Zip | 27713-2206
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Country | US
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Telephone | 919-361-5304
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Fax | 919-806-0851
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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 | 21281
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License Number State | NC
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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 | 15675-40
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License Number State | WI
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