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NPI Code Detail

MEDICARE: DR. JACOB MADERICH PHARM D

MEDICARE: DR. JACOB MADERICH 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
1183500000XPharmacist120051MN

General Provider Information

NPI Number : 1679858864
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACOB MADERICH PHARM D
Provider Business Mailing Address
First Line : 4501 GRAND AVE
Second Line :
City : DULUTH
State : MN
Zip : 55807-2754
Country : US
Telephone Number : 218-628-2897
Fax Number :
Provider Business Practice Location Address
First Line : 4501 GRAND AVE
Second Line :
City : DULUTH
State : MN
Zip : 55807-2754
Country : US
Telephone Number : 218-628-2897
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2011
Last Update Date : 10/19/2011

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