Active NPI
Elon Jacobs, PHARM.D
- Pharmacist
- Oklahoma City, OK
National Provider Identifier
1124391065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 13649
- Practice address
- 4149 Highline Blvd
Oklahoma City, OK 73108-2103 - Phone
- (800) 940-9963
- Fax
- (405) 557-1083
- NPI assigned
- Feb 22, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13649 | OK | Primary |
| Pharmacist | 183500000X | 055481 | NY | |
| Pharmacist | 183500000X | 65154 | CA |
Addresses
Primary practice location
4149 Highline Blvd
Oklahoma City, OK 73108-2103
Mailing address
4149 Highline Blvd
Oklahoma City, OK 73108-2103
Phone (800) 940-9963
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055481 | NY | MD | Endodontist |
| 13649 | OK | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341792000000",
"number": "1124391065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4149 HIGHLINE BLVD",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731082103",
"telephone_number": "800-940-9963",
"fax_number": "405-557-1083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4149 HIGHLINE BLVD",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731082103",
"telephone_number": "800-940-9963",
"fax_number": "405-557-1083"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "ELON",
"credential": "PHARM.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-02-22",
"last_updated": "2012-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "13649",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "055481",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "65154",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.