Provider Demographics
NPI:1285785642
Name:JACOBSEN, JANET L (RPH)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 POMMEL PL
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7573
Mailing Address - Country:US
Mailing Address - Phone:515-226-0192
Mailing Address - Fax:
Practice Address - Street 1:15500 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7983
Practice Address - Country:US
Practice Address - Phone:515-987-0377
Practice Address - Fax:515-987-0532
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist