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NPI Code Detail

MEDICARE: JADE MICHELLE JACOBO PHARMD

MEDICARE:   JADE MICHELLE JACOBO  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
1183500000XPharmacist18412NV

General Provider Information

NPI Number : 1851976849
Entity Type Code : Individual
Provider Name (Legal Business Name) : JADE MICHELLE JACOBO PHARMD
Provider Business Mailing Address
First Line : 3927 MONTONE AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89141-8798
Country : US
Telephone Number : 702-499-7130
Fax Number :
Provider Business Practice Location Address
First Line : 1807 W CRAIG RD
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-0217
Country : US
Telephone Number : 702-633-6532
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2021
Last Update Date : 03/11/2021

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Directions to “ JADE MICHELLE JACOBO PHARMD” Practice Location

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