Provider Demographics
NPI:1316626815
Name:BUDA, JACOB (PHARMD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:BUDA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-9393
Mailing Address - Country:US
Mailing Address - Phone:570-417-2751
Mailing Address - Fax:
Practice Address - Street 1:495 BEVERLY DR
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-9393
Practice Address - Country:US
Practice Address - Phone:570-417-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4576161835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist