Active NPI
Travis David Jacob, PHARM D
- Pharmacist
- Munster, IN
National Provider Identifier
1508273376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH. 03234093
- Practice address
- 901 Macarthur Blvd
Munster, IN 46321 - Phone
- (219) 836-1600
- NPI assigned
- Jul 14, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH. 03234093 | OH | Primary |
Addresses
Primary practice location
901 Macarthur Blvd
Munster, IN 46321
Mailing address
911 S Main St
Centerville, OH 45458-5801
Other practice location 1
911 S Main St
Centerville, OH 45458-5801
Phone (937) 291-3707
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 |
|---|---|---|---|
| RPH. 03234093 | OH | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Pharmacy
- Longview, TX
- NPI 1629956545
-
- Pharmacy
- Centerville, OH
- NPI 1881609840
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528848000000",
"number": "1508273376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "911 S MAIN ST",
"city": "CENTERVILLE",
"state": "OH",
"postal_code": "454585801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 MACARTHUR BLVD",
"city": "MUNSTER",
"state": "IN",
"postal_code": "46321",
"telephone_number": "219-836-1600"
}
],
"practiceLocations": [
{
"address_1": "911 S Main St",
"address_purpose": "LOCATION",
"city": "Centerville",
"state": "OH",
"postal_code": "454585801",
"country_code": "US",
"telephone_number": "937-291-3707",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACOB",
"first_name": "TRAVIS",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-14",
"last_updated": "2018-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "RPH. 03234093",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Munster, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.