MEDICARE: JACOB RUBEN DEHECK

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	127347	MN

General Provider Information

NPI Number	:	1912824061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB RUBEN DEHECK

Provider Business Mailing Address
First Line	:	1221 W LAKE ST STE 200
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-3565
Country	:	US
Telephone Number	:	612-824-1036
Fax Number	:	612-824-7862

Provider Business Practice Location Address
First Line	:	1221 W LAKE ST STE 200
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-3565
Country	:	US
Telephone Number	:	612-824-1036
Fax Number	:	612-824-7862

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

Provider Enumeration Date	:	06/30/2026
Last Update Date	:	06/30/2026

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