MEDICARE: BENJAMIN JACOBI 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	122993	MN

General Provider Information

NPI Number	:	1497353205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN JACOBI PHARM.D.

Provider Business Mailing Address
First Line	:	2206 WHITE OAK DR
Second Line	:
City	:	NORTH MANKATO
State	:	MN
Zip	:	56003-4273
Country	:	US
Telephone Number	:	612-759-2374
Fax Number	:

Provider Business Practice Location Address
First Line	:	1881 MADISON AVE
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-6200
Country	:	US
Telephone Number	:	507-625-1660
Fax Number	:

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

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	10/14/2020

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