Joe Jacob
Individual provider Active NPI Pharmacist · N Bellmore, NY
NPI 1124340575 · NPPES record last updated Feb 25, 2010
Key facts
- NPI
- 1124340575
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- I037661-1 (NY)
- Practice address
- 703 Newbridge Rd
N Bellmore, NY 11710-1613 - Phone
- (516) 409-9442
- Fax
- (516) 409-4126
- NPI assigned
- Feb 25, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I037661-1 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | I037661-1 | NY | Yes |
Addresses
Primary practice location
703 Newbridge Rd
N Bellmore, NY 11710-1613
Mailing address
703 Newbridge Rd
N Bellmore, NY 11710-1613
Phone (516) 409-9442
Other providers in N Bellmore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.