MEDICARE: JACOB THOMAS THORNTON PHARMD

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	PS58857	FL

General Provider Information

NPI Number	:	1821558552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB THOMAS THORNTON PHARMD

Provider Business Mailing Address
First Line	:	2632 OAK PARK CIR
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33328-6722
Country	:	US
Telephone Number	:	954-665-7829
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 SW 13TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33130-4211
Country	:	US
Telephone Number	:	305-860-7770
Fax Number	:

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

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	03/20/2019

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