MEDICARE: BRANDI JERREL JACOBS PHARM.D.

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	33906	TN

General Provider Information

NPI Number	:	1942593249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI JERREL JACOBS PHARM.D.

Provider Business Mailing Address
First Line	:	134 RELIANCE DR
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-1733
Country	:	US
Telephone Number	:	318-243-5782
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 E COLLEGE ST
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-2032
Country	:	US
Telephone Number	:	615-441-1146
Fax Number	:

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

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	05/18/2011

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