Provider Demographics
NPI:1588332555
Name:COVERT, JACOB CHRISTOPHER (PHARMD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:CHRISTOPHER
Last Name:COVERT
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 1:1275 W PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4886
Mailing Address - Country:US
Mailing Address - Phone:301-668-8716
Mailing Address - Fax:301-360-0513
Practice Address - Street 1:1275 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4886
Practice Address - Country:US
Practice Address - Phone:301-668-8716
Practice Address - Fax:301-360-0513
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24506183500000X
PARP451133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist