MEDICARE: JACOB MIDDAUGH 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	RP455931	PA

General Provider Information

NPI Number	:	1134892037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB MIDDAUGH PHARM. D

Provider Business Mailing Address
First Line	:	6148 COUNTY ROAD 18
Second Line	:
City	:	ALMA
State	:	NY
Zip	:	14708-9701
Country	:	US
Telephone Number	:	585-808-2460
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 N MAIN ST
Second Line	:
City	:	PORT ALLEGANY
State	:	PA
Zip	:	16743-1336
Country	:	US
Telephone Number	:	814-642-5021
Fax Number	:

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

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	08/11/2021

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