Melissa C Jacob

Primary specialty

PharmacistTaxonomy code 183500000X

License

PHCY-01184 Issued in NH

Practice address

606 Valley St
Manchester, NH 03103-4305

Phone

(603) 377-0347

NPI assigned

Jul 15, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Walgreen Co

  dba Walgreens #21605

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1578135794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 VALLEY ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031034305",
            "telephone_number": "603-668-7924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 VALLEY ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031034305",
            "telephone_number": "603-377-0347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "MELISSA",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-15",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NH",
            "license": "PHCY-01184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "na",
            "affiliation": "N",
            "address_1": "606 Valley St",
            "city": "Manchester",
            "state": "NH",
            "country_code": "US",
            "postal_code": "031034305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Destiny Jackson
• Erin L Jackson, D.O.
• Hannah Elizabeth Jackson, RBT
• Jacinda L Jackson, LCMHC
• Eyas Jacob, MD
• Lisa Cathleen Jacobus, MSW, LICSW
• Jennifer Jacques, PMHNP
• Kavita Kumari Jain, OTR
• Celine P Jalbert, LCMHC & MLADC
• James Borbotsina, DDS

• Pharmacist in Manchester, NH
• Providers in Manchester, NH by specialty
• Pharmacist in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; 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.