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NPI Code Detail

MEDICARE: JACOB STEFAN

MEDICARE: JACOB STEFAN
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
1183500000XPharmacist03124731OH

General Provider Information

NPI Number : 1184224149
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB STEFAN
Provider Business Mailing Address
First Line : 6244 WILMINGTON PIKE
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-7024
Country : US
Telephone Number : 937-848-3218
Fax Number :
Provider Business Practice Location Address
First Line : 6244 WILMINGTON PIKE
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-7024
Country : US
Telephone Number : 937-848-3218
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2020
Last Update Date : 10/29/2020

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