MEDICARE: JACOB WORTHINGTON

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	1835P2201X	Ambulatory Care Pharmacist	03444814	OH

General Provider Information

NPI Number	:	1508654245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB WORTHINGTON

Provider Business Mailing Address
First Line	:	3877 EVELYN DR
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-2134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3605 WARRENSVILLE CENTER RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-5203
Country	:	US
Telephone Number	:	440-743-3004
Fax Number	:

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

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	06/28/2026

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