Jean K Jacob, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

PCT0009700 Issued in CT

Practice address

2117 Boston Ave
Bridgeport, CT 06610-3030

Phone

(203) 493-4251

NPI assigned

Sep 4, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Main Street Pharmacy 3 LLC

  • Pharmacy
  • Bridgeport, CT
  • NPI 1316249352
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451088000000",
    "number": "1417280652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2117 BOSTON AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066103030",
            "telephone_number": "203-493-4251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2117 BOSTON AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066103030",
            "telephone_number": "203-493-4251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "JEAN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-04",
        "last_updated": "2015-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CT",
            "license": "PCT0009700",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NJ",
            "license": "28RI02804900",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051292532",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marcus Kirk Jackson, LCSW
• Natacha Jackson
• Samyiah Destiny Jackson
• Tatiana Y Jackson
• Jack Jacob, D.O.
• Juliet Jacob
• Cheryl Jacobs
• Kathryn Lohotsky Jaffer, CRNA
• Danielle Marie Jagoe
• Payal Jain, DDS

• Pharmacist in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Pharmacist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.