Active NPI
Bryce Anton Jacobsen, PHARMD
- Pharmacist
- Farmington Hills, MI
National Provider Identifier
1952028714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302414689
- Practice address
- 30055 Northwestern Hwy Ste 225
Farmington Hills, MI 48334-3231 - Phone
- (865) 377-0248
- NPI assigned
- Oct 24, 2022
- Sex
- Male
- 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 | 5302414689 | MI | Primary |
Addresses
Primary practice location
30055 Northwestern Hwy Ste 225
Farmington Hills, MI 48334-3231
Mailing address
46822 W Ridge Dr
Macomb, MI 48044-3583
Phone (586) 383-3731
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 |
|---|---|---|---|
| 5302414689 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666569600000",
"number": "1952028714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "46822 W RIDGE DR",
"city": "MACOMB",
"state": "MI",
"postal_code": "480443583",
"telephone_number": "586-383-3731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30055 NORTHWESTERN HWY STE 225",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483343231",
"telephone_number": "865-377-0248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSEN",
"first_name": "BRYCE",
"middle_name": "ANTON",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-10-24",
"last_updated": "2022-10-24",
"certification_date": "2022-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302414689",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington Hills, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.