MEDICARE: ANN ELIZABETH JACOB PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051292317	IL

General Provider Information

NPI Number	:	1114228111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN ELIZABETH JACOB PHARM D

Provider Business Mailing Address
First Line	:	11 S WILLE ST
Second Line	:	UNIT 501
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-3111
Country	:	US
Telephone Number	:	224-392-8298
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 LEE ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1518
Country	:	US
Telephone Number	:	847-299-4488
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2010
Last Update Date	:	11/06/2010

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