MEDICARE: JACOBE BOSTON PHARMD, 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	025903	LA

General Provider Information

NPI Number	:	1760335103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOBE BOSTON PHARMD, RPH

Provider Business Mailing Address
First Line	:	8455 FERN AVE APT 1808
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-5789
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1453 E BERT KOUNS INDUSTRIAL LOOP
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-6800
Country	:	US
Telephone Number	:	318-681-5435
Fax Number	:

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

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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