Provider Demographics
NPI:1699262998
Name:FELTON, JACOB PAUL (PHARMD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:PAUL
Last Name:FELTON
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 1:7320 S 169TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-4168
Mailing Address - Country:US
Mailing Address - Phone:402-301-7136
Mailing Address - Fax:
Practice Address - Street 1:8710 F ST STE 118
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1532
Practice Address - Country:US
Practice Address - Phone:402-397-8330
Practice Address - Fax:402-331-2207
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR27919183500000X
NE14693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist