Jacob Sullivan Krebs, PHARM.D
Individual provider Active NPI Pharmacist · Eureka, MO
NPI 1386085348 · NPPES record last updated Jul 7, 2013
Key facts
- NPI
- 1386085348
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 2013022775 (MO)
- Practice address
- 131 Eureka Towne Center Dr
Eureka, MO 63025-1031 - Phone
- (636) 938-9425
- NPI assigned
- Jul 7, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2013022775 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East LP | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2013022775 | MO | Yes |
Addresses
Primary practice location
131 Eureka Towne Center Dr
Eureka, MO 63025-1031
Mailing address
1122 Sidney St # 1
Saint Louis, MO 63104-4311
Other providers in Eureka, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2013. 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.