MEDICARE: JACOB G NEESMITH PHARM.D.,RPH.

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	015784	GA

General Provider Information

NPI Number	:	1235300625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB G NEESMITH PHARM.D.,RPH.

Provider Business Mailing Address
First Line	:	2592 RILEY DR NW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-1813
Country	:	US
Telephone Number	:	770-514-7379
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 WHITLOCK AVE NW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-5455
Country	:	US
Telephone Number	:	770-421-7675
Fax Number	:	770-426-3678

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

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	03/13/2008

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