MEDICARE: HAMLEY JACOBS

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	RPH026487	GA
2	183500000X	Pharmacist	PS48511	FL

General Provider Information

NPI Number	:	1689018897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAMLEY JACOBS

Provider Business Mailing Address
First Line	:	1740 MEMORIAL DR
Second Line	:
City	:	WAYCROSS
State	:	GA
Zip	:	31501-1044
Country	:	US
Telephone Number	:	912-338-9127
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 MEMORIAL DR
Second Line	:
City	:	WAYCROSS
State	:	GA
Zip	:	31501-1044
Country	:	US
Telephone Number	:	912-338-9127
Fax Number	:

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

Provider Enumeration Date	:	04/18/2013
Last Update Date	:	04/18/2013

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Directions to “ HAMLEY JACOBS ” Practice Location

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