Jacob A Mock, PHARMD, BCGP

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

RPH-0013183 Issued in OR

Practice address

2630 Central Ave
Eielson AFB, AK 99702-2301

Phone

(907) 377-6606

NPI assigned

Jun 10, 2009

Last updated

Mar 29, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jake A Mock Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1902032535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 COWLES ST",
            "address_2": "FAIRBANKS MEMORIAL HOSPITAL",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 CENTRAL AVE",
            "city": "EIELSON AFB",
            "state": "AK",
            "postal_code": "997022301",
            "telephone_number": "907-377-6606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 Cowles St",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997015907",
            "country_code": "US",
            "telephone_number": "907-458-5615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOCK",
        "first_name": "JACOB",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PHARMD, BCGP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-10",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "OR",
            "license": "RPH-0013183",
            "primary": true
        },
        {
            "code": "1835G0303X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Geriatric",
            "state": "AK",
            "license": "102058",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAKE",
            "last_name": "MOCK",
            "middle_name": "A",
            "credential": "PHARMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Turner Arizona Macphee, DPT
• Bradley Martin
• Eric Dylan Mason, IDMT
• Karen L Medbury, MSW, LCSW
• Landru Derek Medvec, IDMT
• Nicholas R Moorehead, PHD
• Sandra Muniz, LPN
• Amanda Nichols
• Eric Noll, OD
• John Joseph Olshefski, M.D.

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Eielson AFB, AK
• Providers in Eielson AFB, AK by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 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.