Active NPI
Lori Jean Jacobs, RPH
- Pharmacist
- Clarkston, WA
National Provider Identifier
1679634281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10319
- Practice address
- 1275 Highland Ave
Clarkston, WA 99403-2846 - Phone
- (509) 758-2555
- NPI assigned
- Dec 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 10319 | WA | Primary |
Addresses
Primary practice location
1275 Highland Ave
Clarkston, WA 99403-2846
Mailing address
2951 Dove LN
Clarkston, WA 99403-1460
Phone (509) 758-5438
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6173801 | Medicaid | WA | |
| 4902981 | Other | WA | NABP |
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10319 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679634281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2951 DOVE LN",
"city": "CLARKSTON",
"state": "WA",
"postal_code": "994031460",
"telephone_number": "509-758-5438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1275 HIGHLAND AVE",
"city": "CLARKSTON",
"state": "WA",
"postal_code": "994032846",
"telephone_number": "509-758-2555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "LORI",
"middle_name": "JEAN",
"name_prefix": "Ms.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "10319",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6173801",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NABP",
"identifier": "4902981",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarkston, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.